RT Journal Article SR Electronic T1 In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology DO 10.3174/ajnr.A6604 A1 V. Preethish-Kumar A1 A. Shah A1 M. Kumar A1 M. Ingalhalikar A1 K. Polavarapu A1 M. Afsar A1 J. Rajeswaran A1 S. Vengalil A1 S. Nashi A1 P.T. Thomas A1 A. Sadasivan A1 M. Warrier A1 A. Nalini A1 J. Saini YR 2020 UL http://www.ajnr.org/content/early/2020/07/02/ajnr.A6604.abstract AB BACKGROUND AND PURPOSE: Duchenne muscular dystrophy is an X-linked disorder characterized by progressive muscle weakness and prominent nonmotor manifestations, such as a low intelligence quotient and neuropsychiatric disturbance. We investigated WM integrity in patients with Duchenne muscular dystrophy using DTI.MATERIALS AND METHODS: Fractional anisotropy and mean, axial, and radial diffusivity (DTI measures) were used to assess WM microstructural integrity along with neuropsychological evaluation in patients with Duchenne muscular dystrophy (n = 60) and controls (n = 40). Exon deletions in the DMD gene were confirmed using multiplex ligation-dependent probe amplification. Patients were classified into proximal (DMD Dp140+) and distal (DMD Dp140–) subgroups based on the location of the exon deletion and expression of short dystrophin Dp140 isoform. WM integrity was examined using whole-brain Tract-Based Spatial Statistics and atlas-based analysis of DTI data. The Pearson correlation was performed to investigate the possible relationship between neuropsychological scores and DTI metrics.RESULTS: The mean ages of Duchenne muscular dystrophy and control participants were 8.0 ± 1.2 years and 8.2 ± 1.4 years, respectively. The mean age at disease onset was 4.1 ± 1.8 years, and mean illness duration was 40.8 ± 25.2 months. Significant differences in neuropsychological scores were observed between the proximal and distal gene-deletion subgroups, with more severe impairment in the distal-deletion subgroup (P < .05). Localized fractional anisotropy changes were seen in the corpus callosum, parietal WM, and fornices in the patient subgroup with Dp140+, while widespread changes were noted in the Dp140– subgroup. The Dp140+ subgroup showed increased axial diffusivity in multiple WM regions relative to the Dp140– subgroup. No significant correlation was observed between clinical and neuropsychological scores and diffusion metrics.CONCLUSIONS: Widespread WM differences are evident in patients with Duchenne muscular dystrophy relative to healthy controls. Distal mutations in particular are associated with extensive WM abnormalities and poor neuropsychological profiles.ADaxial diffusivityFAfractional anisotropyDMDDuchenne muscular dystrophyIQintelligence quotientMDmean diffusivityMDFRSMuscular Dystrophy Functional Rating ScaleMLPAmultiplex ligation-dependent probe amplificationRDradial diffusivityTBSSTract-Based Spatial Statistics