ComCat: Combating Covariate Effects in Brain Analysis

As neuroimaging analysis shifts toward large-scale, multi-site studies, managing the unwanted variability introduced by combining heterogeneous datasets has become a critical challenge. Although tools such as ComBat and its neuroimaging extensions are widely used to address this variability, they only permit the modeling of categorical site effects and cannot account for continuous sources of confounding, such as image quality, head motion, and acquisition parameters. We introduce ComCat, an extension of the ComBat framework that preserves biologically relevant covariates while removing the effects of categorical site indicators and continuous nuisance variables. The latter are modeled as smooth nonlinear functions via B-spline basis expansion. ComCat is applicable to a broad range of brain analysis tasks, including voxel- and surface-based morphometry, normative modeling, and machine learning-based prediction. To demonstrate its capabilities, we evaluated ComCat on brain age prediction across five datasets covering complementary multi-site harmonization scenarios: ON-Harmony (10 subjects x 6 scanners; n = 80); the Buchert traveling-phantom dataset (1 subject x 116 scanners; n = 531); the Tohoku single-scanner, varying-acquisition dataset (n = 121); MR-ART (148 subjects with varying motion levels); and an ABIDE subset comprising 229 control subjects and 208 individuals with autism spectrum disorder across 14 scanners. Using image quality measures derived from CAT12 as continuous nuisance variables, ComCat reduced the mean absolute error (MAE) in brain age prediction relative to ComBat-GAM in all five datasets, including the two scenarios where site information was unavailable or uninformative. In the ABIDE dataset, ComCat improved harmonization while preserving the difference between the control and ASD groups, demonstrating that scanner-related variance can be removed without affecting biologically meaningful signals. ComCat can operate with or without site labels and is agnostic to the source of image quality metrics.