Reduced White Matter Integrity in Patients With End-Stage and Non-end-Stage Chronic Kidney Disease: A Tract-Based Spatial Statistics Study

Background and Purpose: Reduced white matter (WM) integrity has been implicated in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD). However, whether the differences in WM abnormalities exist in ESRD and non-end-stage CKD (NES-CKD) remains unclear. Hence, this study aimed to investigate the WM microstructural changes between the two stages using diffusion tensor imaging (DTI) and explore the related influencing factors.Methods: Diffusion tensor imaging’ images were prospectively acquired from 18 patients with ESRD, 22 patients with NES-CKD, and 19 healthy controls (HCs). Tract-based spatial statistics (TBSS) was performed to assess the voxel-wise differences in WM abnormalities among the three groups. The relationships between DTI parameters and biochemical data were also analyzed.Results: Compared with NES-CKDs, FA value was significantly decreased, and AD value increased in ESRDs mainly in brain regions of bilateral anterior thalamic radiation (ATR), the genu and body of corpus callosum (CC), bilateral anterior corona radiata, superior corona radiata, and superior longitudinal fasciculus. Besides, extensive and symmetrical deep WM damages were observed in patients with ESRD, accompanied by increased MD and RD values. Multiple regression analysis revealed that uric acid and serum phosphorus level can be used as independent predictors of WM microstructural abnormalities in clusters with statistical differences in DTI parameters between ESRD and NES-CKD groups.Conclusion: In the progression of CKD, patients with ESRD have more severe WM microstructural abnormalities than NES-CKDs, and this progressive deterioration may be related to uric acid and phosphate levels.

Factors associated with brain white matter damage in type 2 diabetes mellitus: a tract-based spatial statistics study

Background The pathogenesis and related factors of central nervous system abnormality in patients with type 2 diabetes mellitus (T2DM) have always been the focus of clinical research. Purpose To compare and analyze the area of white matter (WM) damage in patients with T2DM based on their level of hemoglobin A1C (HBA1c) and discuss any related factors. Material and Methods Based on their levels of HBA1c, 87 patients with T2DM were divided into three groups (Group B, C, or D), of which 29 non-diabetic volunteers served as the control group (Group A). DTI data analysis was based on tract-based spatial statistics (TBSS). The obtained parameters were compared among each group and the relevant clinical factors were analyzed. Results For age, sex, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MoCA) scores, there were no statistically significant differences among groups. For fractional anisotropy (FA) and radial diffusivity (RD) of WM, there were statistically significant differences ( P < 0.05, two-tailed, FWE corrected) in the local area of corpus callosum, corona radiate, superior longitudinal fasciculus, etc. Most of these were significantly correlated with body mass index (BMI), left systolic blood pressure (SBP_L), and β2 microglobulin. Conclusion Before the cognitive function was obviously impaired, abnormalities of FA and RD had been found in the corpus callosum, corona radiate, and upper fasciculus in patients with T2DM, which suggested that the damage mainly occurred in the myelin sheath of WM and may be related to systemic vascular damage.

Structural brain connectivity in children with developmental dyscalculia

Developmental dyscalculia (DD) is a neurodevelopmental disorder specific to arithmetic learning even with normal intelligence and age-appropriate education. Difficulties often persist from childhood through adulthood. Underlying neurobiological mechanisms of DD, however, are poorly understood. This study aimed to identify possible structural connectivity alterations in DD. We evaluated 10 children with pure DD (11.3 plus-or-minus sign 0.7 years) and 16 typically developing (TD) peers (11.2 plus-or-minus sign 0.6 years) using diffusion tensor imaging. We first assessed white matter microstructure with tract-based spatial statistics. Then we used probabilistic tractography to evaluate tract lengths and probabilistic connectivity maps in specific regions. At whole brain level, we found no significant microstructural differences in white matter between children with DD and TD peers. Also, seed-based connectivity probabilities did not differ between groups. However, we did find significant differences in regions-of-interest tracts which had previously been related to math ability in children. The major findings of our study were reduced white matter coherence and shorter tract lengths of the left superior longitudinal/arcuate fasciculus and left anterior thalamic radiation in the DD group. Furthermore, lower white matter coherence and shorter pathways corresponded with the lower math performance as a result of the correlation analyses. These results from regional analyses indicate that learning, memory and language-related pathways in the left hemisphere might underlie DD. Keywords: Mathematical learning disability, diffusion tensor imaging, superior longitudinal fasciculus, anterior thalamic radiation, probabilistic tractography, tract-based spatial statistics

White Matter Abnormalities in Patients With Parkinson's Disease: A Meta-Analysis of Diffusion Tensor Imaging Using Tract-Based Spatial Statistics

Background: Tract-based spatial statistics (TBSS) studies based on diffusion tensor imaging (DTI) have revealed extensive abnormalities in white matter (WM) fibers of Parkinson's disease (PD); however, the results were inconsistent. Therefore, a meta-analytical approach was used in this study to find the most prominent and replicable WM abnormalities of PD.Methods: Online databases were systematically searched for all TBSS studies comparing fractional anisotropy (FA) between patients with PD and controls. Subsequently, we performed the meta-analysis using a coordinate-based meta-analytic software called seed-based d mapping. Meanwhile, meta-regression was performed to explore the potential correlation between the alteration of FA and the clinical characteristics of PD.Results: Out of a total of 1,701 studies that were identified, 23 studies were included. Thirty datasets, including 915 patients (543 men) with PD and 836 healthy controls (449 men), were included in the current study. FA reduction was identified in the body of the corpus callosum (CC; 245 voxels; z = −1.739; p &lt; 0.001) and the left inferior fronto-occipital fasciculus (IFOF) 118 voxels; z = −1.182; p &lt; 0.001). Both CC and IFOF maintained significance in the sensitivity analysis. No increase in FA was identified, but the percentage of male patients with PD was positively associated with the value of FA in the body of the CC.Conclusions: Although some limitations exist, DTI is regarded as a valid way to identify the pathophysiology of PD. It could be more beneficial to integrate DTI parameters with other MRI techniques to explore brain degeneration in PD.