Tractometry-Based Quantification of Along-Tract White-Matter Hemispheric Asymmetry in Alzheimer's Disease.

White-matter hemispheric asymmetry is a fundamental property of human brain organization and is known to change in aging, neurodevelopment, and neurodegenerative disorders. Tractometry analyzes diffusion-derived microstructural measures along the full length of tracts, localizing changes to specific tract-segments rather than collapsing tracts into a single value. Yet, existing frameworks lack a principled way to quantify left-right hemispheric asymmetries along homologous tracts. Here, we introduce an asymmetry-aware tractometry framework that integrates a symmetric white-matter atlas with BUAN (Bundle Analytics) to enable anatomically consistent, along-tract comparison of homologous pathways. By defining homologous bundles with a shared template and consistent orientation, each left-hemisphere segment is directly matched to its right-hemisphere counterpart, enabling principled, segment-wise comparison and revealing spatially localized asymmetries along-tract. Applying this framework to diffusion MRI data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) comprising 1,215 subjects, we demonstrate how this approach reveals systematic left-right asymmetries across major white-matter pathways and show how these patterns differentiate cognitively normal (CN) individuals from those with mild cognitive impairment (MCI) and dementia. This method provides a sensitive and anatomically grounded tool for studying hemispheric specialization and its disruption in aging and disease, and establishes a general approach for asymmetry-aware tractometry in population neuroimaging studies.