Imputation-Based Harmonization Mitigates Site Effects Without Data Leakage in Machine Learning Studies

Neuroimaging studies that pool data across clinical sites often suffer from site effects - variability in imaging measures that arises from technical heterogeneity across sites as opposed to true biological signal. While numerous harmonization methods have been proposed to remove site effects from imaging features, less attention has been placed on how to incorporate harmonization models into common machine-learning pipelines. We demonstrate that current approaches for integration either suffer from data leakage, fail to fully remove site effects from the target data, or attenuate true biological associations during the harmonization process. To address these issues, we propose Multiple Imputation for Removing Technical Heterogeneity (MIRTH), which uses imputed outcomes to harmonize the test data. We benchmark MIRTH's performance using both simulated and real-world volumetric data from the Alzheimer's Disease Neuroimaging Initiative and the Baltimore Longitudinal Study of Aging, demonstrating that MIRTH can achieve high predictive accuracy while avoiding inflated performance when the outcome is imbalanced across clinical sites.