Empirical validation of race-neutral normative brain morphometry models across ethnoracially diverse populations

R Ruiyang Ge (Djavad Mowafaghian Centre for Brain Health, University of British Columbia) Y Yuetong Yu (Djavad Mowafaghian Centre for Brain Health, University of British Columbia) F Faye New (Department of Psychiatry, Icahn School of Medicine) S Shalaila S. Haas (Department of Psychiatry, Icahn School of Medicine) N Nicole Sanford (Djavad Mowafaghian Centre for Brain Health, University of British Columbia) K Kevin Yu (Djavad Mowafaghian Centre for Brain Health, University of British Columbia) P Paul Allen (Institute of Psychiatry, Psychology and Neuroscience) S Seda Arslan (Department of Psychology, Bilkent University) M Mihai Avram (Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck) S Stefan Borgwardt (Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck) N Nicolas A. Crossley (Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile) C Camilo de la Fuente-Sandoval (Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía) M Masaki Fukunaga (Section of Brain Function Information, National Institute for Physiological Sciences) J Jia-Hong Gao (Changping Laboratory) A Alfonso Gonzalez-Valderrama (School of Medicine, Universidad Finis Terrae) R Ryota Hashimoto (Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry) F Felice Iasevoli (Department of Neuroscience, University School of Naples “Federico II”) D Daniel Keeser (Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich) K Kader Kubat (National Magnetic Resonance Research Center, Bilkent University) V Veena Kumari (Centre for Cognitive and Clinical Neuroscience, Brunel University of London) J Junya Matsumoto (Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry) U Urvakhsh M. Mehta (Department of Psychiatry, National Institute of Mental Health and Neurosciences) K Kiyotaka Nemoto (Department of Medical Informatics and Management and Psychiatry, Institute of Medicine, University of Tsukuba) G Giuseppe Pontillo (Department of Advanced Biomedical Sciences, University of Naples “Federico II”) F Florian J. Raabe (Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich) F Francisco Reyes-Madrigal (Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía) N Neelabja Roy (Department of Psychiatry, National Institute of Mental Health and Neurosciences) D Didenur Şahin-Çevik (National Magnetic Resonance Research Center, Bilkent University) T Tuba Sahin-Ilikoglu (National Magnetic Resonance Research Center, Bilkent University) T Timothea Toulopoulou (Department of Psychiatry, Icahn School of Medicine) E Elias Wagner (Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty University of Augsburg) G Guoyuan Yang (Advanced Research Institute of Multidisciplinary Sciences, School of Medical Technology, School of Life Science, Beijing Institute of Technology) M Mariana Zurita (Institute of Psychiatry, Psychology and Neuroscience) P Paul M. Thompson (Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California) S Sophia Frangou (Djavad Mowafaghian Centre for Brain Health, University of British Columbia)

Abstract

Normative models of brain morphometry quantify individual deviations from typical anatomical patterns and hold promise for enhancing clinical decision-making. However, their clinical utility depends critically on demonstrating generalizability across diverse ethnoracial populations. We previously developed sex-specific, race-neutral normative models for cortical thickness, surface area, and subcortical volumes using brain scans from a large international sample of healthy individuals, as part of the CentileBrain Project, a global initiative to provide open-access, neuroimaging reference models. The primary aim of the present study was to empirically evaluate the generalizability and accuracy of these pretrained models across multiple ethnoracial groups. To this end, we tested model performance in independent samples of healthy individuals from Africa, Asia, Europe, and the Americas, with ethnoracial classification defined either by self-identification or genetic ancestry (N = 4,862). We further compared performance against normative models developed exclusively from a single-population Chinese cohort. Across all groups, as well as in the pooled sample, the pretrained CentileBrain models demonstrated consistently high accuracy, with relative mean absolute error values below 10% for subcortical volume and surface area and below 5% for cortical thickness. Model performance was highly concordant across self-identified and ancestry-defined groups. In a separate analysis, the CentileBrain models performed comparably to a population-specific model when applied to an independent ancestry-matched sample. These findings provide empirical support for the generalizability of race-neutral normative models developed on large and diverse samples and underscore their potential utility for individualized neuroimaging assessment across ethnoracially diverse populations.

Article Details

Volume / Issue Vol. 123, Issue 20
Published May 19, 2026
ISSN 0027-8424
Publisher National Academy of Sciences

Authors (35)

R

Ruiyang Ge

Djavad Mowafaghian Centre for Brain Health, University of British Columbia

Y

Yuetong Yu

Djavad Mowafaghian Centre for Brain Health, University of British Columbia

F

Faye New

Department of Psychiatry, Icahn School of Medicine

S

Shalaila S. Haas

Department of Psychiatry, Icahn School of Medicine

N

Nicole Sanford

Djavad Mowafaghian Centre for Brain Health, University of British Columbia

K

Kevin Yu

Djavad Mowafaghian Centre for Brain Health, University of British Columbia

P

Paul Allen

Institute of Psychiatry, Psychology and Neuroscience

S

Seda Arslan

Department of Psychology, Bilkent University

M

Mihai Avram

Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck

S

Stefan Borgwardt

Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck

N

Nicolas A. Crossley

Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile

C

Camilo de la Fuente-Sandoval

Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía

M

Masaki Fukunaga

Section of Brain Function Information, National Institute for Physiological Sciences

J

Jia-Hong Gao

Changping Laboratory

A

Alfonso Gonzalez-Valderrama

School of Medicine, Universidad Finis Terrae

R

Ryota Hashimoto

Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry

F

Felice Iasevoli

Department of Neuroscience, University School of Naples “Federico II”

D

Daniel Keeser

Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich

K

Kader Kubat

National Magnetic Resonance Research Center, Bilkent University

V

Veena Kumari

Centre for Cognitive and Clinical Neuroscience, Brunel University of London

J

Junya Matsumoto

Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry

U

Urvakhsh M. Mehta

Department of Psychiatry, National Institute of Mental Health and Neurosciences

K

Kiyotaka Nemoto

Department of Medical Informatics and Management and Psychiatry, Institute of Medicine, University of Tsukuba

G

Giuseppe Pontillo

Department of Advanced Biomedical Sciences, University of Naples “Federico II”

F

Florian J. Raabe

Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich

F

Francisco Reyes-Madrigal

Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía

N

Neelabja Roy

Department of Psychiatry, National Institute of Mental Health and Neurosciences

D

Didenur Şahin-Çevik

National Magnetic Resonance Research Center, Bilkent University

T

Tuba Sahin-Ilikoglu

National Magnetic Resonance Research Center, Bilkent University

T

Timothea Toulopoulou

Department of Psychiatry, Icahn School of Medicine

E

Elias Wagner

Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty University of Augsburg

G

Guoyuan Yang

Advanced Research Institute of Multidisciplinary Sciences, School of Medical Technology, School of Life Science, Beijing Institute of Technology

M

Mariana Zurita

Institute of Psychiatry, Psychology and Neuroscience

P

Paul M. Thompson

Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California

S

Sophia Frangou

Djavad Mowafaghian Centre for Brain Health, University of British Columbia