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Research ArticleFUNCTIONAL

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

Y. Xie, Y. Zhang, W. Qin, S. Lu, C. Ni and Q. Zhang
American Journal of Neuroradiology March 2017, 38 (3) 617-625; DOI: https://doi.org/10.3174/ajnr.A5042
Y. Xie
aFrom the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China
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Y. Zhang
aFrom the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China
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W. Qin
aFrom the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China
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S. Lu
bDepartments of Radiology (S.L.)
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C. Ni
cCardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.
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Q. Zhang
aFrom the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    WM regions showed significant differences in DKI metrics between patients with T2DM and controls. The regions with decreased FA (upper row), increased MD (middle row), and decreased MK (lower row) in patients with T2DM were overlapped on the FA template. Color bars represent the t values of intergroup comparisons.

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    Fig 2.

    Correlations between DKI parameters and clinical/cognitive variables in the patients with T2DM and controls. A, Correlation between decreased FA in the rPF_WM and RT of ANT. B, Correlation between increased RD in rPF_WM and RT of ANT. C, Correlation between increased MD in the superior rPF_WM and disease duration. D, Correlation between increased AD in the superior rPF_WM and disease duration. E, Correlation between increased RD in the superior rPF_WM and disease duration.

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    Fig 3.

    WM regions that showed significant differences in DKI metrics (red) and DTI metrics (blue) between patients with T2DM and controls were overlapped on the FA template. Green represents the overlapped region of the results of the DKI and the DTI between patients with T2DM and controls.

Tables

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    Table 1:

    Demographic and clinical informationa

    T2DM (n = 58)Healthy Controls (n = 58)StatisticsP
    Demographics
        Age (yr)56.09 ± 8.1654.66 ± 7.03t = 1.012.314
        Sex (M/F)34:2435:23χ2 = 0.036.850
        Education level (yr)11.72 ± 3.3111.07 ± 2.64t = 1.178.241
    Clinical information
        Disease duration (mo)91.25 ± 69.81–––
        BMI (kg/m2)25.57 ± 2.1924.64 ± 2.99t = 1.915.058
        Systolic BP (mm Hg)130 (110–170)122.5 (100–170)z = −1.713.087
        Diastolic BP (mm Hg)80 (60–100)80 (60–100)z = −1.015.310
        FBG (mmol/L)8.06 ± 2.815.13 ± 0.65t = 7.717<.001
        HbA1c (%)8.35 ± 2.105.56 ± 0.33t = 10.020<.001
        HbA1c (mmol/mol)67.76 ± 22.8737.31 ± 3.62t = 10.013<.001
        Total cholesterol (mmol/L)5.06 ± 1.355.39 ± 0.91t = −1.541.126
        Triglycerides (mmol/L)1.66 (0.49–8.03)1.24 (0.46–7.35)z = −1.698.090
        HDL (mmol/L)1.15 ± 0.271.27 ± 0.31t = −2.167.032
        LDL (mmol/L)3.17 ± 0.933.47 ± 0.85t = −1.799.075
    • Note:—FBG indicates fasting blood glucose; HDL, high-density lipoprotein; LDL, low-density lipoprotein; BP, blood pressure; BMI, body mass index.

    • ↵a Data distributed normally or non-normally are presented as mean ± SD or median (range).

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    Table 2:

    Cognitive informationa

    T2DM (n = 58)Healthy Controls (n = 58)StatisticsP
    MMSE score29.21 ± 0.8929.50 ± 0.94t = −1.720.088
    RT of ANT (ms)536.53 ± 71.31566.51 ± 92.09t = −1.911.059
    ACC of ANT (%)98.65 ± 1.8397.89 ± 4.49t = 1.157.250
    RPEP (%)0.07 ± 0.020.08 ± 0.02t = −1.908.059
    SAS32.19 ± 6.1630.71 ± 5.24t = 1.397.165
    SDS34.09 ± 7.7931.64 ± 7.07t = 1.772.079
    Long-term memory10.75 ± 2.6511.04 ± 2.85t = −0.555.580
    Short-term memory47.14 ± 9.2548.69 ± 9.29t = −0.879.381
    Forward Digit Span8.25 ± 1.508.18 ± 1.26t = 0.258.797
    Backward Digit Span5.07 ± 1.455.13 ± 1.07t = −0.230.818
    TMT-A (s)61.65 ± 25.5458.15 ± 27.60t = 0.686.494
    • Note:—ACC of ANT indicates the accuracy rate of Attention Network Test; RPEP, the percentage of the preservative response error; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depressive Scale; TMT-A, Trail Making Test A; MMSE, Mini-Mental State Examination.

    • ↵a Data are presented as mean ± SD.

    • View popup
    Table 3:

    Brain regions showing significant voxel-based intergroup differences in DKI metrics

    Structure NameMetricsCluster Voxel No.Peak t ValueMNI Coordinates
    XYZ
    Splenium of CCFA184−4.679−2−348
    rPF_WMFA78−4.483302620
    Superior rPF_WMMD2045.094103636
    Middle rPF_WMMD5215.077145210
    Inferior rPF_WMMD903.9003842−2
    lPF_WMMD804.372−463226
    rST_WMMD1894.608340−22
    Splenium of CCMD753.882−2−388
    lECMD2615.068−3212−2
    PonsMD1334.487−6−28−42
    Splenium of CCMK172−4.4270−3214
    PonsMK150−4.659−6−28−42
    • Note:—lPF_WM indicates left prefrontal white matter; MNI, Montreal Neurological Institute; rST_WM, right superior temporal white matter.

    • View popup
    Table 4:

    Intergroup differences of the AD and RD values that contributed to the altered FA valuesa

    T2DM (n = 58)Healthy Controls (n = 58)FP
    rPF_WM
        AD, ×10−5 mm2/s111.10 ± 4.83111.79 ± 4.630.967.328
        RD, ×10−5 mm2/s82.06 ± 5.4878.84 ± 4.7112.095.001
    Splenium of CC
        AD, ×10−5 mm2/s288.14 ± 26.33270.95 ± 33.148.490.004
        RD, ×10−5 mm2/s179.24 ± 36.37151.55 ± 41.7713.321<.001
    • ↵a Data are presented as mean ± SD. The intergroup comparisons were performed with ANCOVA adjusted for age, sex, and years of education.

    • View popup
    Table 5:

    Intergroup differences of the AD and RD values that contributed to the altered MD valuesa

    T2DM (n = 58)Healthy Controls (n = 58)FP
    Superior rPF_WM
        AD, ×10−5 mm2/s111.06 ± 6.52105.23 ± 4.2531.431<.001
        RD, ×10−5 mm2/s93.28 ± 6.4187.75 ± 4.4928.488<.001
    Middle rPF_WM
        AD, ×10−5 mm2/s113.59 ± 6.04108.52 ± 3.4831.472<.001
        RD, ×10−5 mm2/s90.12 ± 6.3985.27 ± 3.5327.982<.001
    Inferior rPF_WM
        AD, ×10−5 mm2/s116.85 ± 5.98112.19 ± 5.5318.548<.001
        RD, ×10−5 mm2/s84.53 ± 5.9581.24 ± 4.3810.752.001
    lPF_WM
        AD, ×10−5 mm2/s121.75 ± 10.54114.50 ± 6.6219.725<.001
        RD, ×10−5 mm2/s107.47 ± 11.4098.84 ± 7.4423.252<.001
    rST_WM
        AD, ×10−5 mm2/s127.10 ± 10.59119.03 ± 6.3822.413<.001
        RD, ×10−5 mm2/s102.70 ± 10.2594.47 ± 5.8525.394<.001
    Splenium of CC
        AD, ×10−5 mm2/s269.21 ± 20.44255.20 ± 24.279.865.002
        RD, ×10−5 mm2/s152.25 ± 32.11127.36 ± 32.8415.805<.001
    lEC
        AD, ×10−5 mm2/s122.54 ± 7.42117.14 ± 4.8421.495<.001
        RD, ×10−5 mm2/s92.85 ± 8.7086.36 ± 6.1422.007<.001
    Pons
        AD, ×10−5 mm2/s222.11 ± 27.07201.58 ± 26.1518.416<.001
        RD, ×10−5 mm2/s177.25 ± 27.60157.84 ± 24.3817.237<.001
    • Note:—lPF_WM indicates left prefrontal white matter; rST_WM, right superior temporal white matter.

    • ↵a Data are presented as mean ± SD. The intergroup comparisons were performed with ANCOVA adjusted for age, sex, and years of education.

    • View popup
    Table 6:

    Intergroup differences of the AK and RK values that contributed to the altered MK valuesa

    T2DM (n = 58)Healthy Controls (n = 58)FP
    Splenium of CC
        AK, ×10−5 mm2/s46.10 ± 2.3947.90 ± 3.1611.249.001
        RK, ×10−5 mm2/s112.35 ± 22.24131.37 ± 26.6216.883<.001
    Pons
        AK, ×10−5 mm2/s66.02 ± 6.1971.75 ± 8.0918.289<.001
        RK, ×10−5 mm2/s83.59 ± 8.9890.75 ± 8.8417.912<.001
    • ↵a Data are presented as mean ± SD. The intergroup comparisons were performed with ANCOVA adjusted for age, sex, and years of education.

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American Journal of Neuroradiology: 38 (3)
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Y. Xie, Y. Zhang, W. Qin, S. Lu, C. Ni, Q. Zhang
White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis
American Journal of Neuroradiology Mar 2017, 38 (3) 617-625; DOI: 10.3174/ajnr.A5042

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White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis
Y. Xie, Y. Zhang, W. Qin, S. Lu, C. Ni, Q. Zhang
American Journal of Neuroradiology Mar 2017, 38 (3) 617-625; DOI: 10.3174/ajnr.A5042
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