Brain microstructural alterations in type 2 diabetes: diffusion kurtosis imaging provides added value to diffusion tensor imaging
To investigate brain microstructural changes in white matter and gray matter of type 2 diabetes mellitus (T2DM) patients using diffusion kurtosis imaging.
Diffusion kurtosis imaging (b values = 0, 1250, and 2500 s/mm2) was performed for 30 T2DM patients and 28 controls. FMRIB Software Library with tract-based spatial statistics was used to analyze intergroup differences in fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), axial kurtosis (K∥), and radial kurtosis (K⊥) of multiple white matter regions. Atlas-based ROI analysis was conducted in gray matter structures and some fiber tracts. Correlations between MK changes and clinical measurements were determined.
In whole-brain tract-based spatial statistics analysis, T2DM patients exhibited abnormalities in 29.6%, 30.4%, 35.4%, 10.5%, and 26.0% of white matter regions as measured by FA, MD, MK, K∥, and K⊥, respectively, when compared to the controls. MK reduction was contributed more by the decreased K⊥. In atlas-based analysis, MK detected more ROIs (27/48) with white matter microstructural changes than FA (13/48) and MD (17/48). MK decreased in bilateral thalamus and caudate, while FA showed statistically significant difference only in the left caudate. MK values negatively correlated with disease duration in the genu of corpus callosum and anterior corona radiata (R = -0.512 and -0.459) and positively correlated with neuropsychological scores in the cingulum (hippocampus) (R = 0.466 and 0.440).
Diffusion kurtosis imaging detects more brain regions with white matter and gray matter microstructural alterations of T2DM patients than DTI metrics. It provides valuable information for studying the pathology of diabetic encephalopathy and may lead to better imaging biomarkers for monitoring disease progression.
• Diffusion kurtosis imaging detects more brain regions with microstructural alterations in white matter and gray matter of T2DM patients than DTI.
• Mean kurtosis changes are associated with disease severity and impaired neuropsychological function in T2DM.
• Diffusion kurtosis imaging demonstrates potential to assess cognitive impairment in T2DM patients and predict disease progression.
KeywordsType 2 diabetes mellitus Diffusion kurtosis imaging Diffusion tensor imaging White matter Gray matter
Diffusion kurtosis imaging
Diffusion tensor imaging
Version 5.0 FMRIB Software Library
Glycosylated hemoglobin A1c
Mini-Mental State Examination
Montreal Cognitive Assessment
Region of interest
Type 2 diabetes mellitus
Tract-based spatial statistics
This study has received funding by the National Natural Science Foundation of China (grant numbers 81601480, 81471230, and 81171308).
Compliance with ethical standards
The scientific guarantor of this publication is Wenzhen Zhu.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in part at the 101st Annual Meeting of the Radiological Society of North America, Chicago, USA, 25–30 November 2015.
• diagnostic or prognostic study
• performed at one institution
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