Leveraging Swin Transformer for enhanced diagnosis of Alzheimer's disease using multi-shell diffusion MRI

Objective: This study aims to support early diagnosis of Alzheimer's disease and detection of amyloid accumulation by leveraging the microstructural information available in multi-shell diffusion MRI (dMRI) data, using a vision transformer-based deep learning framework. Methods: We present a classification pipeline that employs the Swin Transformer, a hierarchical vision transformer model, on multi-shell dMRI data for the classification of Alzheimer's disease and amyloid presence. Key metrics from DTI and NODDI were extracted and projected onto 2D planes to enable transfer learning with ImageNet-pretrained models. To efficiently adapt the transformer to limited labeled neuroimaging data, we integrated Low-Rank Adaptation. We assessed the framework on diagnostic group prediction (cognitively normal, mild cognitive impairment, Alzheimer's disease dementia) and amyloid status classification. Results: The framework achieved competitive classification results within the scope of multi-shell dMRI-based features, with the best balanced accuracy of 95.2% for distinguishing cognitively normal individuals from those with Alzheimer's disease dementia using NODDI metrics. For amyloid detection, it reached 77.2% balanced accuracy in distinguishing amyloid-positive mild cognitive impairment/Alzheimer's disease dementia subjects from amyloid-negative cognitively normal subjects, and 67.9% for identifying amyloid-positive individuals among cognitively normal subjects. Grad-CAM-based explainability analysis identified clinically relevant brain regions, including the parahippocampal gyrus and hippocampus, as key contributors to model predictions. Conclusion: This study demonstrates the promise of diffusion MRI and transformer-based architectures for early detection of Alzheimer's disease and amyloid pathology, supporting biomarker-driven diagnostics in data-limited biomedical settings.