Table 4.

Challenges to the adoption of BV assessment in routine clinical practice

Category	Topic
Physiological factors [11, 57, 64, 66, 70, 74, 75]	Age Body mass index Diurnal variation Genotype (ApoE expression) Hydration state Menstrual cycle
Disease-related factors [11, 57, 64, 74–77]	Fluid-level changes attributable to inflammation (edema) Fluid-level changes attributable to resolution of inflammation (treatment-related pseudoatrophy)
Habits and comorbidities [11, 64, 66, 74]	Alcohol consumption Cardiovascular hypertension Diabetes mellitus Obesity Smoking
MRI-related factors [11, 57, 64, 65, 74, 76]	Changes in acquisition protocols Changes in scanner type and scanner upgrades Factors influencing scan quality (head motion, distortions, inhomogeneity artifacts) Measurement error Non-standardized quantification methods Patient repositioning in the scanner
Logistical factors [11, 57, 64, 65, 76]	Reimbursement Complexity of use (e.g. PACS integration) Lack of normative data Methods dependent on real-time data Poor integration of some image formats

ApoE apolipoprotein E gene, BV brain volume, MRI magnetic resonance imaging, PACS Picture Archiving and Communication System