Eur Radiol DOI 10.1007/s00330-014-3466-5
MAGNETIC RESONANCE
Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: A diffusion-tensor study Ruijie Zhang & Kai Liu & Linfeng Yang & Tao Zhou & Shaowen Qian & Bo Li & Zhaohui Peng & Min Li & Shengpeng Sang & Qingjun Jiang & Gang Sun
Received: 13 June 2014 / Revised: 10 September 2014 / Accepted: 7 October 2014 # European Society of Radiology 2014
Abstract Objectives The purpose of this investigation was to examine the association between cognition disorders and microstructural white matter (WM) changes in maintenance hemodialysis end-stage renal disease (ESRD) patients. Methods Twenty-six maintenance hemodialysis ESRD patients and 28 healthy controls underwent diffusion tensor imaging (DTI), Mini Mental State Examination (MMSE), Trial Marking Test-A&B (TMT-A&B), and white matter hyperintensity (WMH) assessment. Tract-based spatial statistics (TBSS) analyses was performed to evaluate WM changes in the patients. Relationships between behavioural performances, clinical data, and the DTI index were tested, respectively, by correlation analysis at the voxel level. Results ESRD patients showed significant decreased fractional anisotropy (FA) in 14 WM regions, and increased mean diffusivity (MD) and radial diffusivity (RD) in widespread regions. Significant positive correlations between FA values and MMSE scores were found in the right anterior corona radiata and the left anterior thalamic radiation; significant negative correlations between the TMT-B time consumption and FA values were Ruijie Zhang and Kai Liu contributed equally to this work. R. Zhang : K. Liu : S. Qian : B. Li : Z. Peng : M. Li : S. Sang : Q. Jiang : G. Sun (*) Department of Medical Imaging, Jinan Military General Hospital, No.25, Shifan Road, Jinan, Shandong Province, China 250031 e-mail: [email protected] L. Yang Department of Medical Imaging, Jinan Maternity and Child Care Hospital, No.2, Jianguo Xiaojing 3 Road, Jinan, Shandong Province, China 250031 T. Zhou Department of Medical Imaging, Laiwu City People’s Hospital, No.001, Xuehu Street Changshao North Road, Laiwu, Shandong Province, China 271100
identified in the bilateral superior longitudinal fasciculus. Positive linear relationships between MD, RD values, and the duration of hemodialysis were found in several WM regions. Conclusion Structural damages to radiation and associative fibre tracts, caused by brain oedema and WM demyelination, may account for the cognitive deficits in ESRD patients. Key Points • Lower FA, higher MD and RD values were found in ESRD patients. • Cognitive deficits in ESRD patients mainly focused on executive dysfunction. • Cognitive impairment in ESRD patients may be associated with damages to WM. • MD and RD are valuable in monitoring WM alteration in ESRD patients. Keywords End-stage renal disease . Cognitive impairment . Executive dysfunction . Diffusion tensor imaging . Tract-based spatial statistics Abbreviations ESRD End-stage renal disease DTI Diffusion tensor imaging FA Fractional anisotropy MD Mean diffusivity AD Axial diffusivity RD Radial diffusivity MMSE Mini Mental State Examination TMT Trial Marking Test
Introduction End-stage renal disease (ESRD) occurs when chronic kidney disease (CKD) progresses to a glomerular filtration rate (GFR)
Eur Radiol
of
MAGNETIC RESONANCE
Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: A diffusion-tensor study Ruijie Zhang & Kai Liu & Linfeng Yang & Tao Zhou & Shaowen Qian & Bo Li & Zhaohui Peng & Min Li & Shengpeng Sang & Qingjun Jiang & Gang Sun
Received: 13 June 2014 / Revised: 10 September 2014 / Accepted: 7 October 2014 # European Society of Radiology 2014
Abstract Objectives The purpose of this investigation was to examine the association between cognition disorders and microstructural white matter (WM) changes in maintenance hemodialysis end-stage renal disease (ESRD) patients. Methods Twenty-six maintenance hemodialysis ESRD patients and 28 healthy controls underwent diffusion tensor imaging (DTI), Mini Mental State Examination (MMSE), Trial Marking Test-A&B (TMT-A&B), and white matter hyperintensity (WMH) assessment. Tract-based spatial statistics (TBSS) analyses was performed to evaluate WM changes in the patients. Relationships between behavioural performances, clinical data, and the DTI index were tested, respectively, by correlation analysis at the voxel level. Results ESRD patients showed significant decreased fractional anisotropy (FA) in 14 WM regions, and increased mean diffusivity (MD) and radial diffusivity (RD) in widespread regions. Significant positive correlations between FA values and MMSE scores were found in the right anterior corona radiata and the left anterior thalamic radiation; significant negative correlations between the TMT-B time consumption and FA values were Ruijie Zhang and Kai Liu contributed equally to this work. R. Zhang : K. Liu : S. Qian : B. Li : Z. Peng : M. Li : S. Sang : Q. Jiang : G. Sun (*) Department of Medical Imaging, Jinan Military General Hospital, No.25, Shifan Road, Jinan, Shandong Province, China 250031 e-mail: [email protected] L. Yang Department of Medical Imaging, Jinan Maternity and Child Care Hospital, No.2, Jianguo Xiaojing 3 Road, Jinan, Shandong Province, China 250031 T. Zhou Department of Medical Imaging, Laiwu City People’s Hospital, No.001, Xuehu Street Changshao North Road, Laiwu, Shandong Province, China 271100
identified in the bilateral superior longitudinal fasciculus. Positive linear relationships between MD, RD values, and the duration of hemodialysis were found in several WM regions. Conclusion Structural damages to radiation and associative fibre tracts, caused by brain oedema and WM demyelination, may account for the cognitive deficits in ESRD patients. Key Points • Lower FA, higher MD and RD values were found in ESRD patients. • Cognitive deficits in ESRD patients mainly focused on executive dysfunction. • Cognitive impairment in ESRD patients may be associated with damages to WM. • MD and RD are valuable in monitoring WM alteration in ESRD patients. Keywords End-stage renal disease . Cognitive impairment . Executive dysfunction . Diffusion tensor imaging . Tract-based spatial statistics Abbreviations ESRD End-stage renal disease DTI Diffusion tensor imaging FA Fractional anisotropy MD Mean diffusivity AD Axial diffusivity RD Radial diffusivity MMSE Mini Mental State Examination TMT Trial Marking Test
Introduction End-stage renal disease (ESRD) occurs when chronic kidney disease (CKD) progresses to a glomerular filtration rate (GFR)
Eur Radiol
of
