Biesbroek J Matthijs, Leemans Alexander, den Bakker Hanna, Duering Marco, Gesierich Benno, Koek Huiberdina L, van den Berg Esther, Postma Albert, Biessels Geert Jan
Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
Dement Geriatr Cogn Disord. 2017;44(5-6):268-282. doi: 10.1159/000485376. Epub 2018 Jan 19.
White matter injury is an important factor for cognitive impairment in memory clinic patients. We determined the added value of diffusion tensor imaging (DTI) of strategic white matter tracts in explaining variance in cognition in memory clinic patients with vascular brain injury.
We included 159 patients. Conventional MRI markers (white matter hyperintensity volume, lacunes, nonlacunar infarcts, brain atrophy, and microbleeds), and fractional anisotropy and mean diffusivity (MD) of the whole brain white matter and of 18 white matter tracts were related to cognition using linear regression and Bayesian network analysis.
On top of all conventional MRI markers combined, MD of the whole brain white matter explained an additional 3.4% (p = 0.014), 7.8% (p < 0.001), and 1.2% (p = 0.119) variance in executive functioning, speed, and memory, respectively. The Bayesian analyses of regional DTI measures identified strategic tracts for executive functioning (right superior longitudinal fasciculus), speed (left corticospinal tract), and memory (left uncinate fasciculus). MD within these tracts explained an additional 3.4% (p = 0.012), 3.8% (p = 0.007), and 2.1% (p = 0.041) variance in executive functioning, speed, and memory, respectively, on top of all conventional MRI and global DTI markers combined.
In memory clinic patients with vascular brain injury, DTI of strategic white matter tracts has a significant added value in explaining variance in cognitive functioning.
白质损伤是记忆门诊患者认知障碍的重要因素。我们确定了关键白质束的扩散张量成像（DTI）在解释血管性脑损伤记忆门诊患者认知差异方面的附加价值。
我们纳入了159名患者。使用线性回归和贝叶斯网络分析，将传统MRI标记物（白质高信号体积、腔隙、非腔隙性梗死、脑萎缩和微出血）以及全脑白质和18条白质束的分数各向异性和平均扩散率（MD）与认知相关联。
在所有传统MRI标记物综合作用的基础上，全脑白质的MD分别在执行功能、速度和记忆方面额外解释了3.4%（p = 0.014）、7.8%（p < 0.001）和1.2%（p = 0.119）的差异。区域DTI测量的贝叶斯分析确定了执行功能（右侧上纵束）、速度（左侧皮质脊髓束）和记忆（左侧钩束）的关键束。在所有传统MRI和全脑DTI标记物综合作用的基础上，这些束内的MD分别在执行功能、速度和记忆方面额外解释了3.4%（p = 0.012）、3.8%（p = 0.007）和2.1%（p = 0.041）的差异。
在血管性脑损伤的记忆门诊患者中，关键白质束的DTI在解释认知功能差异方面具有显著的附加价值。
