White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis

• Published in: American journal of neuroradiology : AJNR 2017-03, Vol.38 (3), p.617-625
• Main Authors: Xie, Y, Zhang, Y, Qin, W, Lu, S, Ni, C, Zhang, Q
• Format: Article
• Language: English
• Subjects: Abnormalities; Adult Brain; Aged; Attention task; Cognitive ability; Cognitive Dysfunction - etiology; Cognitive Dysfunction - psychology; Corpus callosum; Corpus Callosum - diagnostic imaging; Corpus Callosum - pathology; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - psychology; Diffusion; Diffusion Tensor Imaging; Female; Functional; Glycated Hemoglobin A - analysis; Humans; Hypoglycemic Agents - therapeutic use; Image Processing, Computer-Assisted; Impairment; Insulin - therapeutic use; Kurtosis; Male; Measurement methods; Medical imaging; Middle Aged; Neuroimaging; Neurology; Neuropsychological Tests; Patients; Pons; Substantia alba; White Matter - diagnostic imaging; White Matter - pathology
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A5042

Increasing DTI studies have demonstrated that white matter microstructural abnormalities play an important role in type 2 diabetes mellitus-related cognitive impairment. In this study, the diffusional kurtosis imaging method was used to investigate WM microstructural alterations in patients with type 2 diabetes mellitus and to detect associations between diffusional kurtosis imaging metrics and clinical/cognitive measurements. Diffusional kurtosis imaging and cognitive assessments were performed on 58 patients with type 2 diabetes mellitus and 58 controls. Voxel-based intergroup comparisons of diffusional kurtosis imaging metrics were conducted, and ROI-based intergroup comparisons were further performed. Correlations between the diffusional kurtosis imaging metrics and cognitive/clinical measurements were assessed after controlling for age, sex, and education in both patients and controls. Altered diffusion metrics were observed in the corpus callosum, the bilateral frontal WM, the right superior temporal WM, the left external capsule, and the pons in patients with type 2 diabetes mellitus compared with controls. The splenium of the corpus callosum and the pons had abnormal kurtosis metrics in patients with type 2 diabetes mellitus. Additionally, altered diffusion metrics in the right prefrontal WM were significantly correlated with disease duration and attention task performance in patients with type 2 diabetes mellitus. With both conventional diffusion and additional kurtosis metrics, diffusional kurtosis imaging can provide additional information on WM microstructural abnormalities in patients with type 2 diabetes mellitus. Our results indicate that WM microstructural abnormalities occur before cognitive decline and may be used as neuroimaging markers for predicting the early cognitive impairment in patients with type 2 diabetes mellitus.