The structural disconnectome: A pathology-sensitive extension of the structural connectome

Brain connectivity is increasingly being studied using connectomes. Typical structural connectome definitions do not directly take white matter pathology into account. Presumably, pathology impedes signal transmission along fibres, leading to a reduction in function. In order to directly study disconnection and localize pathology within the connectome, we present the disconnectome, which only considers fibres that intersect with white matter pathology. To show the potential of the disconnectome in brain studies, we showed in a cohort of 4199 adults with varying loads of white matter lesions (WMLs) that: (1) Disconnection is not a function of streamline density; (2) Hubs are more affected by WMLs than peripheral nodes; (3) Connections between hubs are more severely and frequently affected by WMLs than other connection types; and (4) Connections between region clusters are often more severely affected than those within clusters.