ABSTRACT
Objective:To explore the oxidative stress of cerebral white matter lesion (WML) and normal-appearing white matter (NAWM) with in vivo proton exchange rate (k ex) MRI on relapse-remitting multiple sclerosis (RRMS) patients. Methods:Clinical and imaging data of 37 patients (case group) with RRMS patients of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology were analyzed retrospectively from November 2018 to November 2021, including 11 males and 26 females aged 18-41 (29±7) years. Another 22 age-matched healthy volunteers (control group) were recruited for the same period, including 4 males and 18 females aged 23-44 years with a median age of 25 (24, 28.25) years. All subjects received conventional MR protocols and chemical exchange saturation transfer imaging. The manifestation of WML on the k ex map and T 1WI images were assessed while the k ex values of WML, NAWM and normal white matter (NWM) of control group were quantitatively evaluated. Student′s t test was used to compare the k ex difference of WML and NAWM in the case group, NAWM in the case group and NWM in the control group, low-signal and isosignal WML in T 1WI. Spearman rank correlation was used to analyze the correlation of the k ex values of WML with patients′ expanded disability status scale (EDSS) score. Results:A total of 272 WML were found in the 37 RRMS patients, and 25.4% (69/272) were T 1-hypointense. The k ex value of WML in the case group [(932±108) s -1] was higher than that of NAWM [(771±26) s -1], and the difference was statistically significant ( t=8.95, P<0.001); the k ex value of NAWM in the case group [(771±26) s -1 ] was higher than that of NWM [(745±26) s -1] in the control group, and the difference was statistically significant ( t=3.96, P<0.001). The k ex value [(1 039±110) s -1] of WML with low signal at T 1WI was higher than that of WML with equal signal [(895±79) s -1], with a statistically significant difference ( t=9.78, P<0.001). Correlation analysis showed that the k ex value of WML in the case group was positively correlated with the EDSS score ( r=0.54, P<0.001). Conclusions:The elevated k ex values of WML and NAWM reflect the cerebral oxidative stress of RRMS patients and are positively correlated to the severity of tissue damage, which suggests the role of oxidative stress in RRMS lesion formation and brain atrophy.
ABSTRACT
Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.
Subject(s)
Humans , Integrative Medicine , Brain/pathology , Cerebral Small Vessel Diseases/pathology , Stroke/complications , Cognitive Dysfunction/complications , Magnetic Resonance ImagingABSTRACT
@#Stenosis and occlusion caused by carotid atherosclerosis is an important cause of ischemic stroke. In recent years, with the continuous development of magnetic resonance imaging (MRI) technology and the introduction of complex network theory, brain network analysis can be used not only to explain the clinical symptoms and cognitive dysfunction in patients with carotid stenosis caused by changes in network topological properties of different brain regions, but also to explore the imaging markers of carotid stenosis, thus providing important reference data for the diagnosis of early asymptomatic carotid stenosis, the selection of individualized intervention programs, and the assessment of efficacy. Brain network analysis has been used as a powerful tool. In this paper, we review the studies of structural and functional brain networks in patients with carotid stenosis, and introduce the definitions of brain network nodes and edges and important topological properties of complex networks. We also analyze the current research on brain network in patients with carotid stenosis, and discuss the challenges and outlook of existing imaging techniques and network construction methodologies in this field.
ABSTRACT
White matter lesions (WMLs) are the extensive damage of periventricular and subcortical white matter caused by different etiology.Previous studies have shown that WMLs is associated with cognitive function, motor function, mood and urination function.Parkinson disease (PD) is a common chronic degenerative disease of the central nervous system.Recently, evidences showed that PD patients have a high susceptibility to WMLs which participates in the progression of motor and cognitive impairment.PD patients have higher risk of WMLs because of cardiovascular autonomic nerve dysfunction, long-term dopamine (DA) treatment and β-amyloid peptides (Aβ) deposition along vessels.Furthermore, recently, more and more evidences showed that WMLs could impact on the motor and cognitive symptoms of PD.WMLs had a significant influence on axial motor symptoms, and was related to executive function, attention, memory, visual-spatial ability and other cognitive impairment.Moreover, the severity of WMLs affects drug and surgical efficacy of patients with PD.Taking active measures to slacken the WMLs progression of PD will contribute to improve symptoms and curative effect.This article summarized the roles of WMLs in the occurrence and development of PD, in order to provide theoretical basis for prevention, diagnosis and treatment of PD.
ABSTRACT
Objective:To investigate the cognitive-related networks of patients with different cognitive impairment related to white matter lesions (WMLs), and explore the correlation between the altered functional connectivity and the executive function.Methods:Patients with white matter lesions in Beijing Tiantan Hospital from January 2016 to December 2020 were selected , who were divided into WML-non-dementia vascular cognitive impairment (WML-VCIND) group( n=19)and WML-vascular dementia (VaD) group( n=19). At the same time, 24 normal control group (NC) with no cognitive impairment with age, gender and education level matched were enrolled. The Stroop B, Stroop C, trail making test(TMT-B) and verbal fluency test (VFT) were used to evaluate the executive function of all subjects. The ICA method was used to identity four cognitive-related RSNs: frontoparietal network (FPN), salience network (SN), default network (DMN), and dorsal attention network (DAN). Using SPSS 20.0 software, the functional connectivity (FC) of the regions of interest of the selected RSNs among the three groups were compared by analysis of covariance, and correlation between the altered FCs and executive function scores were explored by Spearman correlation analysis. Results:(1) The FC of the medial prefrontal cortex (MPFC)-left inferior parietal lobe (IPL.L) in the VaD group(0.267±0.320) was significantly lower than that in the NC group (0.520±0.253)( P=0.005). The FC of MPFC-posterior cingulate (PCC) was significantly lower in the VaD group(0.655±0.284) than that in the VCIND group(0.810±0.232) ( P=0.017). The FC of MPFC-left insula and MPFC-left dorsolateral prefrontal cortex (DLPFC.L)was significantly higher in the VaD group(0.411±0.277, 0.545±0.311)than that in the VCIND group(0.239±0.308, 0.353±0.270)( P=0.044, 0.028). The FC of the left superior parietal lobe (SPL.L)-right dorsolateral prefrontal cortex (DLPFC.R) in the VCIND group(0.488±0.157) was significantly higher than that in the NC group(0.301±0.257) ( P=0.010). The FC of MPFC-left insula and MPFC-DLPFC.L was higher in NC group than that in VaD group ( P=0.020, 0.037). (2) The FC of MPFC-PCC was negatively correlated with Stroop C score ( r=-0.279, P=0.036), and TMT-B score ( r=-0.313, P=0.018). The FC of MPFC-IPL.L was negatively correlated with Stroop B score ( r=-0.311, P=0.018), Stroop C score( r=-0.308, P=0.020) and TMT-B score ( r=-0.367, P=0.005), while positively correlated with VFT score ( r=0.357, P=0.006). The FC of SPL.L-DLPFC.R was positively correlated with the Stroop B score ( r=0.305, P=0.021). Conclusion:There are certain differences in the functional connectivity between brain areas within the cognitive related brain networks, and the differences in FC between different brain areas are correlated with executive function scores. The changes of the FC may indicate possibly decline in executive function, which can explain the mechanism of cognitive declines.
ABSTRACT
White matter lesions in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) are common brain microstructural changes, the mechanism of which is still not clear, including decreased cerebral perfusion, oxidative stress, inflammatory damage, etc. At present, white matter lesions are mainly evaluated by magnetic resonance imaging. White matter lesions in patients with OSAHS are often manifested as cognitive dysfunction such as inattention, decreased executive ability and memory loss. Continuous positive airway pressure can relieve the white matter lesions and improve the cognitive function of some patients with OSAHS. Further study on the pathogenesis and early imaging characteristics of OSAHS white matter lesions is expected to provide targets and evidence for early intervention.
ABSTRACT
Hyperacute treatment after onset of cerebral infarction includes tissue plasminogen activator (t-PA）therapy for thrombolysis and endovascular treatment (EVT）with thrombectomy devices. Although reported infrequently, it has been noted that delayed white matter lesions may appear even when recanalization is obtained for occluded blood vessels. We report the rehabilitation progress of a patient treated with t-PA therapy and EVT for right internal carotid artery (ICA）occlusion in whom a delayed white matter lesion appeared in the subacute phase. In this case, EVT was performed after cerebral infarction, and the occluded blood vessel was completely reopened. After hyperacute treatment, mild motor paralysis was observed and basic movements were all assisted, but physical functions and movement abilities improved with continued treatment and rehabilitation. However, consciousness disorder and higher brain dysfunction appeared in the subacute phase, and motor paralysis progressed. This change in symptoms were thought to be due to a delayed white matter lesion that appeared after EVT for cerebral infarction. Physical functions were aggravated, but symptoms improved biphasically. There remain many unclear points about delayed white matter lesions, and there are various reports as to whether or not worsening symptoms eventually improve. Even if imaging shows that a delayed white matter lesion persists, as in this case, symptoms may again recover. Therefore it is necessary to be careful with rehabilitation.
ABSTRACT
Hyperacute treatment after onset of cerebral infarction includes tissue plasminogen activator (t-PA) therapy for thrombolysis and endovascular treatment (EVT) with thrombectomy devices. Although reported infrequently, it has been noted that delayed white matter lesions may appear even when recanalization is obtained for occluded blood vessels. We report the rehabilitation progress of a patient treated with t-PA therapy and EVT for right internal carotid artery (ICA) occlusion in whom a delayed white matter lesion appeared in the subacute phase. In this case, EVT was performed after cerebral infarction, and the occluded blood vessel was completely reopened. After hyperacute treatment, mild motor paralysis was observed and basic movements were all assisted, but physical functions and movement abilities improved with continued treatment and rehabilitation. However, consciousness disorder and higher brain dysfunction appeared in the subacute phase, and motor paralysis progressed. This change in symptoms were thought to be due to a delayed white matter lesion that appeared after EVT for cerebral infarction. Physical functions were aggravated, but symptoms improved biphasically. There remain many unclear points about delayed white matter lesions, and there are various reports as to whether or not worsening symptoms eventually improve. Even if imaging shows that a delayed white matter lesion persists, as in this case, symptoms may again recover. Therefore it is necessary to be careful with rehabilitation.
ABSTRACT
Objective:To investigate multimodality imaging characteristics and clinical features of lymphomatosis cerebri (LC) and reasons for misdiagnosis,with the goal of potentially facilitating an early and accurate diagnosis for this often-missed disease.Methods:Clinical data and cerebral multimodality imaging findings from 11 patients with LC proven basing on pathology in the Affiliated Hospital of Guizhou Medical University from November 30, 2011 to December 28, 2020 were retrospectively extracted, analyzed, and reviewed in combination with the literatures.Results:The common presenting symptoms with subacute onset included cognitive decline (8/11), gait disturbance (9/11), and behavioral disturbance (5/11). Test of cerebrospinal fluid showed that the number of cells and the level of protein increased (8/10), the sugar content (2/10) and chloride (4/10) decreased. The imaging manifestations of 11 patients with LC were diffuse lesions of bilateral cerebral white matter in the both deep and lobar lesion distribution, involving the cerebral cortex and subcortical white matter in eight cases (8/11), basal ganglia in seven cases (7/11), thalamus in five cases (5/11), cerebellum in six cases and brain stem in six cases (6/11). All 11 patients showed equal or slightly low-density shadows on CT plain scan and slightly longer T 1WI and T 2WI signals on magnetic resonance imaging. Six cases (6/11) had no obvious enhancement in the early stage, and five cases and six follow-up cases showed heterogenous spots, patches, nodules or clusters of distinct enhancement. Diffusion-weighted imaging showed non restricted diffusion in nine (9/11) cases initially diagnosed, and restricted diffusion in two cases (2/11) and nine follow-up cases, which were hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient maps. Five patients (5/5) presented a marked decrease in N-acetyl aspartic acid (NAA)/creatine (Cr) and increase in choline (Cho)/Cr on hydrogen proton magnetic resonance spectrum, including an increase in lipid/Cr in three cases. One case (1/3) showed no abnormal increase in lesion metabolism, and two cases (2/3) showed slightly increased uptake on positron emission tomography/CT. Conclusions:Diffuse bilateral cerebral lesions especially in deep and lobar region, without enhancement or with patchy enhancement, marked decrease in NAA/Cr and increase in Cho/Cr and Lip/Cr are suggestive of LC. Misdiagnosis may be mainly due to insufficient understanding and improper brain biopsy.
ABSTRACT
Objective:To explore the relationship between small-worldness of brain network and cognitive impairment in patients with white matter lesions (WMLs) based on diffusion tensor imaging (DTI). Methods:From January, 2016 to December, 2017, 46 WMLs patients and 36 controls matched genders, ages and education levels from Beijing Tiantan Hospital were screened with DTI. The patients were divided into vascular cognitive impairment non-dementia (VCIND) and vascular dementia (VaD) groups according to the results of cognitive assessments. The brain structure network was created based on DTI data, and the topological properties of the whole-brain small-world network were calculated, and the correlation between the small-worldness and the severity of cognitive impairment was analyzed. Results:The global efficiency, local efficiency, shortest path length and clustering coefficient were different between the patients and the controls (F > 3.252, P < 0.05), as well as the properties of the small-world network, λ, γ and σ (F > 7.378, P < 0.01). The λ, γ and σ were correlated with the total score of Montreal Cognitive Assessment (|r| > 0.402, P < 0.05). Conclusion:The brain structure network is small-world network for patients with WMLs, and the decrease of small-world properties may relate to the cognitive impairment.
ABSTRACT
Objective To analyze the correlation between cerebral atrophy and white matter lesions (WML) in magnetic resonance imaging (MRI) by quantitative and qualitative methods. Methods Two hundred and seventy-two patients with WML admitted to the Department of Neurology of Taizhou Central Hospital from January 2015 to December 2017 were enrolled, by adopting MCMxxxVI 9.0 TM image processing tool and Analyze 9.0TM image editing tool, the volume within the skull, whole brain tissue, cerebrospinal fluid, subarachnoid volume on the surface of the brain, gray matter, normal brain white matter and diseased white matter were quantitatively determined in the MRI, Fazekas visual score was used to qualitatively evaluate the WML of MRI, and the correlation between brain atrophy and WML was analyzed. Results General linear model analysis showed that the WML volume had a negative correlation with total brain atrophy or decreased whole brain volume (β = -0.432, P = 0.004), especially with deep brain atrophy, namely WML volume had a significant positive correlation with the increase of ventricular volume (β = 0.098, P = 0.031), and it had no correlation with superficial brain atrophy or the increase of subarachnoid volume on the surface of the brain (β = 0.088, P = 0.547). Fazekas rating scale used for the correlation analysis of WML and brain atrophy also showed similar results. After adjusting for the gender and skull content volume, it was shown that the WML volume was well fitted with brain volume model, and so was the WML with the following volumes: cerebral white matter volume without any pathological changes, the whole brain tissue volume, gray matter volume models (brain volume R2 = 0.25, cerebral white matter volume with no pathological changes R2 = 0.35, whole brain tissue volume R2 = 0.77, gray matter volume R2 = 0.25, all P < 0.05). Conclusion MRI analysis showed WML was associated with brain atrophy, primarily with deep brain atrophy.
ABSTRACT
Objective Investigating alterations of axon microstructures in white matter lesions in a rat model of hypertension. Methods Eighteen male Sprague-Dawley rats were randomly divided into sham operation group (n=9) and operation group (n=9). Operation group received two kidneys two clips surgeries and bilateral common carotid arteries ligations. In the 12th week after common carotid arteries ligation, rats were evaluated by Morris Water Maze test and then sacrificed for evaluation of pathological features, including small arteries' pathologies, white matter lesions, glia changes and axon micro organizations. Results Morris Water Maze test showed that escape latencies was significantly higher in operation group than in sham operation group. The number of times of cross-over cite in the target quadrant was significantly lower in the operation group than in sham operation group (P＜0.05). Compared with sham operation group, operation group showed a series of pathological features, such as arteriosclerosis, leukoaraiosis, loss of oligodendrocyte and disorganized paranode. Conclusions White matter lesion is a chronic progressive disease which involves both demyelination and axon injuries.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the correlation of apolipoprotein AI (ApoAI), ApoB, ApoB/ApoAI and the severity of brain white matter lesions (WML).</p><p><b>METHODS</b>A total of 648 patients with WML confirmed by brain magnetic resonance imaging (MRI) were divided into mild WML group (=386) and moderate to severe WML group (=262) according to evaluations with the Fazekas scale. The demographic data, blood biochemical parameters and the levels of ApoAI, ApoB and ApoB/AI ratio were compared between the two groups to identify the risk factors of moderate to severe WML.</p><p><b>RESULTS</b>Univariate analysis showed that age, gender, hypertension, diabetes, coronary heart disease, previous stroke, homocysteine, HDL-C, ApoAI, and ApoB/AI ratio all differed significantly between the two groups ( < 0.05), but ApoB levels were similar between them ( > 0.05). Multivariate logistic regression analysis revealed that with ApoAI and ApoB/AI ratio as the continuous variables, after adjustment for the compounding factors, ApoB/AI ratio was an independent risk factor (OR=11.456, 95% : 3.622-36.229, < 0.001) and ApoAI was an independent protective factor for moderate to severe WML (OR=0.068, 95% : 0.018-0.262, < 0.001). With the upper quartiles of ApoAI level (1.38 g/L) and ApoB/AI ratio (0.58) as their respective cutoff values, patients with a high ApoAI level and a low ApoB/AI ratio were found to have the lowest incidence of moderate to severe WML ( < 0.001).</p><p><b>CONCLUSIONS</b>An increased ApoB/AI ratio is an independent risk factor and an increased ApoAI level is an independent protective factor for moderate to severe WML.</p>
ABSTRACT
Objective To investigate the characteristics of the ecological execution function in patients with white matter lesions ( WML) and its influencing factors. Methods 43 cases of magnetic resonance imaging( MRI) find-ings in patients with WML were selected. In the same period, 27 patients who were matched in age and educational level, and brain MRI examination showed normal were selected as the control group. The experimental group and the control group were evaluated by the behavior rating inventory of executive function-adult version ( BRIEF-A) . Results Including the each factor score, global executive composite(GEC), behavioral regulation index(BRI) and metacogniton index( MI) score of WML patients were significantly higher than the control group, the differ-ences were statistically significant (P＜0. 05). In the severe group, the BRI, MI and total score were higher than those in the moderate group and mild group. Compared with the mild group, the BRI, MI and total score in patients with moderate group were notable higher (P＜0. 05). Similarly, the scores of all factors in the severe group were all higher than those in the mild group, and the scores of inhibition, plan and organization were higher than those in the moderate group. There was a significant difference in shift, emotional control, self monitoring, initiation, work-ing memory and organization between the moderate group and the mild group ( P ＜0. 05 ) . There was statistical difference on the scores of each factor, BRI, MI and total score between group deep white matter lesions ( DWML) and group periventricular lesions(PVL) (P＜0. 05). Multiple linear regression analysis showed that the inhibition, emotional control, self-monitoring, MI, initiation, working memory, planning, organization and total score were positively correlated with lesion severity. There was a significant positive correlation between BRI and the level of education and the severity of the disease. At the same time, the BRI was negatively correlated with lesion site. Conclusion The each factor score, BRI, MI and total score of BRIEF-A scale are elevated in WML patients, which is related to the severity of the disease and the site of the lesion.
ABSTRACT
Objective@#To investigate the imaging features of cerebral small vessel disease(SVD) in systemic lupus erythematosus(SLE) patients with impaired renal function and their related risk factors.@*Methods@#Seventy-six SLE patients and forty age- and sex-matched healthy controls were recruited, and SLE patients were divided into the impaired renal function group [estimated glomerular filtration rate (eGFR) <90 ml/(min·1.73 m2)] (n=38) and the normal renal function group [eGFR≥90 ml/(min·1.73 m2)] (n=38) according to their eGFR. All subjects underwent brain MRI, cognitive and psychiatric testing. The SVD scores were measured, total white matter hyperintensity (WMH) and SVD scores were calculated, and the risk factors of SVD scores were analyzed by using ordinal logistic regression.@*Results@#SLE patients in the impaired renal function group showed higher basal ganglia PVS, centrum semiovale perivascular space (PVS), periventricular WMH, deep WMH and total SVD scores compared with normal controls or patients with normal renal function (H=44.568, 31.380, 31.172, 43.419, 24.317, P<0.001) . The ordinal logistic regression analysis showed that C-reactive protein was a risk factor for SVD in patients with SLE(OR=1.323, P<0.01).@*Conclusion@#SLE patients with impaired renal function had a higher SVD burden on MR imaging, particularly PVS in the basal ganglia and deep WMH, which was affected by the C-reactive protein level.
ABSTRACT
Objective To investigate the predictive role of cerebral white matter lesions (WML) and subcortical atrophy on cognitive function in patients with acute ischemic stroke (AIS) after 3 months.Methods 233 cases of AIS patients admitted to hospital continuously from September 2016 to March 2018 were enrolled and all of them underwent brain MRI.The degree of WML on FLAIR was evaluated according to the Fazekas grading standard.The linear measurement of subcortical atrophy on T1WI was carried out on the subcortical brain atrophy index,including EVANS ratio (ER),inverse cella media index (iCMI),caudate head index (CHI) and basal cistern index (BCI).Demographic,clinical and imaging data of all patients were also recorded.Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were conducted at 3 months after AIS.The patients were divided into normal cognitive function (NCI) group and post stroke cognitive impairment (PSCI) group according to evaluation results of MMSE and MoCA.Multivariate logistic regression analysis was used to screen the independent risk factors of cognitive impairment.Results Univariate analysis showed that age (t=-4.233,P=0.000),sex (x2 =7.501,P=0.006),education (H=21.188,P=0.000),NHISS score (H =5.791,P=0.016),history of atrial fibrillation (x2 =6.484,P=0.011),TIA (x2 =9.015,P=0.003),smoking history (x2 =6.943,P=0.008),Fazekas WML score (x2 =27.885,P=0.000),EVANS ratio (H =31.129,P =0.000),inverse cella media index (H =9.434,P =0.002),caudate head index (H=15.148,P=0.000),basal cistern index (t=-1.979,P=0.049) and baseline cognitive function (x2=136.994,P=0.000) were related to cognitive impairment in patients with AIS after 3 months (P＜0.05).Multivariate logistic regression analysis showed that WML score (OR=3.416,P=0.047,95％CI:1.017-11.482),EVANS ratio (OR=1.245,P=0.038,95％CI:1.012-1.531) and caudate head index (OR =1.187,P=0.040,95 ％ CI:1.008-1.397) were risk factors for cognitive impairment in AIS patients after 3 monfths adjusting for age,education,disease severity and baseline cognitive function.Conclusion WML,EVANS ratio and caudate head index can predict short-term cognitive function in patients with AIS.
ABSTRACT
Objective To explore abnormal microstmctural changes of white matter in patients with white matter lesions using diffusion tensor imaging(DTI),and to determine the association of such abnormalities of DTI parameters with cognitive function.Methods The objects who have already confirmed with WML were collected from March 2012 to February 2018 through magnetic resonance imaging (MRI) scan from the neurology department of Beijing Tiantan Hospital.Use The hamilton depression scale(HAMD) and the hamilton anxiety scale (HAMA) to eliminate anxiety and depression,and divided into WML-CN group,WML-VCIND group and WML-VAD group with Mini-mental state examination (MMSE),Montreal Cognitive Assessment (MOCA)and clinical dementia rating(CDR).In addition,select the healthy elderly people without WML by MRI scan as the normal control group.All of the subjects were detected with the superconduct magnetic resonance imaging system (German SIEMENS 3.0T) for the DTI scanning.Original images were processed with VBA.Then explore the changes of FA and MD of DTI in whole brain and regions of interest in NC group,WML-CN group,WML-VCIND group and WWML-VAD group,and its correlation with the severity of cognitive impairment in patients with WML.Results The damage degree of the fiber microstructure of brain white matter was significantly correlated with the total grade point of MoCA (P＜0.01).In figure FA,the variance analysis of F test results showed that the significant brain areas were the splenium of the corpus callosum,the genu of corpus callosum,bilateral posterior internal capsule,retrolenticular part of internal capsule,anterior thalamic radiation,partial inferior longitudinal fasciculus and inferior fronto-occipital fasciculus,cingulate,external capsule,upper and posterior part of the radiation crowns,partial superior longitudinal fasciculus,etc.(P＜0.05 after FWE correction based on TFCE method).In Figure MD,the variance analysis of F test results showed that the statistically significant brain areas mainly included the left external capsule and hook,partial genu and splenium of corpus callosum,Bilateral,bilateral inferior fronto-occipital fasciculus,inferior longitudinal fasciculus,anterior thalamic radiation,retrolenticular part of internal capsule,cingulate,etc (P＜ 0.05 after FWE conection based on TFCE).Conclusion No matter whether cognitive impairment exists in patient with WML or not,all DTI parameters are different from those of normal people.The integrity of white matter fiber has been damaged with different degrees.The more severe the cognitive impairment in the external manifestations of patients with WML,the greater the damage to the intrinsic white matter microstructure.
ABSTRACT
Objective To study the effect of white matter lesions location on cognitive function by comparing the correlation between the anatomical location of white matter lesions and cognitive function in leukoaraisosis(LA)patients. Methods A total of 75 LA patients with different degrees of white matter le-sion were randomly recruited.The modified Scheltens scale,Manolio scale and Fazekas scale were utilized to assess the severity of white matter lesions(WMLs)by two physicians.Montreal cognitive assessment (MoCA)was used to evaluate the cognitive function.The correlation between WMLs location and cognitive function was analyzed by spearman rank correlation analysis.The t-test was used to test the differences of periventricular white matter lesions with cognitive impairment(PWMLs-CI)and periventricular white matter lesions with cognitive normal(PWMLs-CN)in each goup. Results For Fazekas scale,PWMLs were signifi-cantly correlated with the decrease scores of MoCA score(r=-0.388,P=0.007),visuospatial and executive (r=-0.466,P=0.000),delayed recall(r=-0.461,P=0.001),abstraction(r=-0.355,P=0.011)and ori-entation(r=-0.337,P=0.016)(P<0.05).For Scheltens scale,PWMLs was negatively correlated with MoCA score(r=-0.390,P=0.003),visuospatial and executive(r=-0.464,P=0.000),delayed recall(r=0.484, P=0.000),attention(r=-0.375,P=0.008)and orientation(r=-0.342,P=0.013)(P<0.05),but not in deep white matter lesions(DWMLs)(P>0.05).Compared with PWMLs-CN,executive function(42.13 ± 0.89),attention(16.36±1.24)and visuospatial(2.25±0.31)in PWMLs-CI had statistical significance(P<0.05). Conclusion White matter lesions location affect cognitive function,PWMLs are more closely related to cognitive impairement,characterized by executive function,attention and visuospatial aspects.
ABSTRACT
Objective To compare the cognitive function of patients with carotid stenosis combined with white matter lesions (WML)after carotid artery stenting (CAS). Methods Total 166 patients with carotid artery stenosis were collected.According to MRI imaging,30 patients with no white matter lesions were included in the control group and 136 patients with white matter lesions were included in the white matter lesions group. They were treated with carotid artery stenting and underwent evaluation on the safety and efficacy of perioperative surgery. CAS failed in two patients because of the inability of guidewire crossing in WML group. Two patients died after CAS (one for cardiac death and one for traumatic accident) in WML group. 162 patients received 1 year follow-up. Cognitive function was assessed before and after CAS. Results Before CAS,WML group's MMSE, digit span forward/backward test, verbal fluency test and MoCA scores (21.8±3.3、6.3±2.1、4.1±1.0、15.1±3.6、20.6±3.1) were lower compared with control (24.3±3.9、7.3±2.6、4.7±1.8、17.7±5.2、22.7±4.2) and ADAS-Cog score was higher compared with control ((15.1±3.3) vs.(12.7±3.3)), P=0.000、0.026、0.039、0.012、0.000、0.011.Three months after CAS,the MMSE,digit span forward test and MoCA scores (23.7±3.6,7.5± 2.4, 23.1±6.9) was higher significantly than those before treatment (21.8±4.3, 6.3±2.09, 20.6±4.13), P<0.05.And the scores of ADAS-Cog was lower((13.2±4.)vs.(15.1±4.3),P<0.05).The scores of digit span backward test in 6 months after treatment was significant higher than those before treatment (4.9 ±2.8,4.1 ±2.2,P<0.05). After 1 year of CAS, the improvement in scores of MMSE, digit span forward test, ADAS-Cog and MoCA in patients with carotid stenosis complicated with WML(3.5±1.3,1.6±0.6,-2.6±0.8,3.6±1.1)was higher significant than control(2.7±1.8, 1.2±0.8, -2.0± 1.3, 2.7 ±1.5),P<0.05. Conclusion CAS can improve cognitive function in Patients with carotid artery stenosis complicated with WML than those who without WML.
ABSTRACT
Objective To investigate the diagnostic value of cranial ultrasonic examination combined with the detection of serum neuron specific enolase(NSE),S100B and interleukin-6(IL-6)on cerebral white matter lesions of premature infant. Methods Thirty-nine premature infants with cerebral white matter injury diagnosed by cranial magnetic resonance imaging (MRI)in Women and Infants Hospital of Zhengzhou City from August 2016 to July 2017 were selected as observation group. Another thirty premature infants without brain white matter injury were selected as control group in the same period. On the 1st , 3rd and 7th day after birth,the serum NSE level was detected by the automatic time resolved fluoroimmunoassay system,the lev-els of serum S100B and IL-6 were detected by double anti sandwich enzyme-linked immunosorbent assay,and the changes of the cerebral white matter echoes around the cerebral ventricles were observed by cranial ultrasonic examination. The sensitivi-ty,specificity and accuracy combined detection of cranial ultrasonic examination combined with serum NSE,S100B and IL-6 in the diagnosis of white matter lesions in premature infants were analyzed. Results The detection rate of cerebral white matter lesions by cranial ultrasonic examination in the control group was 6. 45％(2 / 31),3. 23％(1 / 31)and 0. 00％(0 / 31)respec-tively;and it was 92. 31％(36 / 39),87. 18％(34 / 39)and 84. 62％(33 / 39)respectively on the 1st ,3rd and 7th day after birth in the observation group;the detection rate of cerebral white matter lesions in the observation group was significantly higher than that in the control group on the 1st ,3rd and 7th day after birth(χ2 = 51. 30,48. 69,49. 63;P < 0. 05). There was no signifi-cant difference in the grayscale value of cerebral white matter among the 1st ,3rd and 7th day after birth in the two groups(P >0. 05). The grayscale value of cerebral white matter in the observation group was significantly higher than that in the control group on the 1st ,3rd and 7th day after birth(P < 0. 05). There was no significant difference in serum S100B and IL-6 levels a-mong the 1st ,3rd and 7th day after birth in the control group(F = 0. 319,0. 307;P > 0. 05). There was the significant difference in serum NSE level among the 1st ,3rd and 7th day after birth in the control group(F = 3. 298,P < 0. 05),the serum NSE level on the 3rd and 7th day after birth was significantly lower than that on the 1st day after birth(P < 0. 05),the serum NSE level on the 7th day after birth was significantly lower than that on the 3rd day after birth(P < 0. 05). The levels of serum NSE,S100B and IL-6 in the observation group showed the downward trend on the 1st ,3rd and 7th day after birth(F = 3. 323,3. 517,3. 706;P < 0. 05). The levels of serum NSE,S100B and IL-6 on the 3rd and 7th day after birth were significantly lower than those on the 1st day after birth in the observation group(P < 0. 05). There was no significant difference in the levels of serum NSE, S100B and IL-6 between the 3rd and 7th day after birth in the observation group(P < 0. 05). The levels of serum NSE,S100B and IL-6 in the observation group were significantly higher than those in the control group on the 1st ,3rd and 7th day after birth (P < 0. 05). In the observation group,the grayscale value of cerebral white matter was positively correlated with the levels of serum NSE,S100B and IL-6 on the 1st day after birth(r = 3. 137,3. 358,3. 056;P < 0. 05);the grayscale value of cerebral white matter was positively correlated with the levels of serum NSE and S100B on the 3rd day after birth(r = 2. 872,2. 347;P <0. 05);the grayscale value of cerebral white matter was positively correlated with serum S100B level on the 7th day after birth (r = 2. 791,P < 0. 05). The sensitivity,specificity and accuracy of combined detection of cranial ultrasonic examination and, serum NSE and S100B in the diagnosis of cerebral white matter lesions in premature infants was 100. 00％,93. 54％ and 97. 14％ respectively. Conclusion The combined detection of cranial ultrasonic examination,serum NSE and S100B can sig-nificantly improve the accuracy of early diagnosis of cerebral white matter lesions.