Toprak Huseyin, Yetis Huseyin, Alkan Alpay, Filiz Mekiya, Kurtcan Serpil, Aralasmak Ayşe, Aksu Mehmet Ş, Cesur Yaşar
1 Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
2 Department of Child Psychology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Br J Radiol. 2016;89(1059):20150680. doi: 10.1259/bjr.20150680. Epub 2016 Jan 5.
To determine whether there were diffusion tensor imaging (DTI) changes in the brain among children with Type 1 diabetes mellitus (DM) and investigate the correlation between the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values and neurocognitive functions.
35 children with Type 1 DM and 21 age-matched healthy control subjects were included. Neurocognitive functions of subjects with Type 1 DM were evaluated. In both groups, FA and ADC values were calculated in 20 different locations. The association between neurocognitive function tests and FA and ADC values was investigated.
Subjects with diabetes had significant changes in FA and ADC values in widespread brain regions compared with the healthy control group. ADC values in the caudate nucleus were negatively associated with verbal point. Increased ADC values in the genu of the corpus callosum were positively associated with Stroop test. There was a negative correlation between the ADC values of the parietal white matter and the judgment of line orientation test. FA values of the inferior longitudinal fasciculus were positively correlated with performance point. However, a negative correlation was noted between FA values of mid-brain and intelligence quotient level as well as another negative correlation between FA values of the posterior crus of the internal capsule and thalamus with verbal point.
Subjects with diabetes demonstrated significant changes in FA and ADC values in widespread brain regions, and such changes could be early features of injury to myelinated fibres or axonal degeneration. Our findings suggest that brain damage may have begun at the cellular level in the initial stage of Type 1 diabetes and neurocognitive impairments may be inevitable.
DTI can demonstrate ADC and FA changes which are well correlated with neurocognitive dysfunction in the brains of children with Type 1 DM. This may help us in guiding preventive measures in early period of the disease before deterioration of neurocognitive functions.
确定1型糖尿病（DM）患儿大脑中是否存在扩散张量成像（DTI）变化，并研究分数各向异性（FA）和表观扩散系数（ADC）值与神经认知功能之间的相关性。
纳入35例1型DM患儿和21例年龄匹配的健康对照者。对1型DM患儿的神经认知功能进行评估。两组均在20个不同部位计算FA和ADC值。研究神经认知功能测试与FA和ADC值之间的关联。
与健康对照组相比，糖尿病患儿大脑广泛区域的FA和ADC值有显著变化。尾状核的ADC值与言语得分呈负相关。胼胝体膝部ADC值升高与Stroop测试呈正相关。顶叶白质的ADC值与直线定向判断测试呈负相关。下纵束的FA值与操作得分呈正相关。然而，中脑的FA值与智商水平呈负相关，内囊后肢和丘脑的FA值与言语得分也呈负相关。
糖尿病患儿大脑广泛区域的FA和ADC值有显著变化，这些变化可能是有髓纤维损伤或轴突退变的早期特征。我们的研究结果表明，1型糖尿病初期脑损伤可能已在细胞水平开始，神经认知障碍可能不可避免。
DTI可显示1型DM患儿大脑中与神经认知功能障碍密切相关的ADC和FA变化。这可能有助于我们在神经认知功能恶化之前的疾病早期指导预防措施。
