PlgFormer: parallel extraction of local-global features for AD diagnosis on sMRI using a unified CNN-transformer architecture.

Introduction: Structural magnetic resonance imaging (sMRI) is an important tool for the early diagnosis of Alzheimer's disease (AD). Previous methods based on voxel, region of interests (ROIs) or patch have limitations in characterizing discriminative features in sMRI for AD as they can only focus on specific local or global features. Methods: We propose a computer-aided AD diagnosis method based on sMRI, named PlgFormer, which considers the extraction of both local and global features. By using a combination of convolution and self-attention, we can extract context features at both local and global levels. In the decision-making layer of the model, we design a feature fusion module that adaptively selects context features through a gating mechanism. Additionally, to account for changes in image input resolution during the downsampling operation, we embed a dynamic embedding block at each stage of the network, which can adaptively adjust the weights of the inputs with different resolutions. Results: We evaluated the performance of our method on dichotomous AD vs. normal control (NC) and mild cognitive impairment (MCI) vs. NC, as well as trichotomous AD vs. MCI vs. NC classification tasks, using publicly available ADNI and XWNI datasets that we collected. On the ADNI dataset, the proposed method achieves classification accuracies of 0.9431 for AD vs. NC, 0.8216 for MCI vs. CN, and 0.6228 for the AD vs. MCI vs. CN task. On the XWNI dataset, the corresponding accuracies are 0.9307, 0.8600, and 0.8672, respectively. The experimental results demonstrate the high precision and robustness of our method in diagnosing people with different stages of cognitive impairment. Conclusion: The findings in our experimental results underscore the clinical potential of our proposed PlgFormer as a reliable and interpretable framework for supporting early and accurate diagnosis of AD using sMRI.