Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, PR China; Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200000, PR China.
Department of Endocrinology and Metabolic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200020, PR China.
Neuroimage Clin. 2019;24:101945. doi: 10.1016/j.nicl.2019.101945. Epub 2019 Jul 18.
Type 2 diabetes mellitus (T2DM) is a serious public health problem, and the phenomenon of T2DM occurring in younger people has directed more attention to functional changes in the brain. In this study, the microstructural integrity of white matter (WM) was evaluated in three groups of middle-aged subjects: healthy controls (HCs) and T2DM patients with and without peripheral microvascular complications (T2DM-C and T2DM-NC patients, respectively).
Diffusion tensor imaging (DTI) and related clinical examinations were performed in 66 subjects, including 20 T2DM-C patients, 20 T2DM-NC patients, 26 age- and sex-matched HCs. Magnetic resonance imaging (MRI) at 3 T was used to perform DTI; then, FSL and tract-based spatial statistics (TBSS) software were used to assess differences in the fractional anisotropy (FA) and mean diffusivity (MD) among the groups. The use of the FA and MD as parameters was evaluated by receiver operating characteristic (ROC) curve analysis.
There were no significant differences in sex or age among the groups, and the clinical data of the groups met the experimental requirements. There was no significant difference in the FA values between the HCs and T2DM-NC groups. Compared with the HCs, the T2DM-C patients showed decreased FA values and increased MD values in the corpus callosum, bilateral anterior limb of the internal capsule, right retrolenticular part of the internal capsule, bilateral posterior thalamic radiation, right superior longitudinal fasciculus, bilateral superior corona radiata and left middle frontal gyrus (P < .01). Compared with the T2DM-NC patients, the T2DM-C patients showed decreased FA values and increased MD values in the corpus callosum, bilateral fornix, right retrolenticular part of the internal capsule, middle cerebral peduncle, right superior longitudinal fasciculus, right posterior thalamic radiation, and left middle frontal gyrus (P < .01).
This study indicates that WM impairment is present in T2DM patients and may be related to microvascular complications. More importantly, this study also shows that such impairment may be diagnosed using the DTI mode of functional MRI before it can be diagnosed clinically.
2 型糖尿病（T2DM）是一个严重的公共卫生问题，年轻人中出现 T2DM 的现象引起了人们对大脑功能变化的更多关注。在这项研究中，我们评估了三组中年受试者的脑白质（WM）微观结构完整性：健康对照组（HCs）和有或无周围微血管并发症的 T2DM 患者（T2DM-C 和 T2DM-NC 患者）。
对 66 名受试者进行了弥散张量成像（DTI）和相关临床检查，包括 20 名 T2DM-C 患者、20 名 T2DM-NC 患者和 26 名年龄和性别匹配的 HCs。使用 3T 磁共振成像（MRI）进行 DTI；然后，使用 FSL 和基于束流的空间统计学（TBSS）软件评估各组间各向异性分数（FA）和平均扩散系数（MD）的差异。通过受试者工作特征（ROC）曲线分析评估 FA 和 MD 作为参数的使用情况。
各组间的性别或年龄无显著差异，且各组的临床资料均符合实验要求。HCs 与 T2DM-NC 组间 FA 值无显著差异。与 HCs 相比，T2DM-C 患者胼胝体、双侧内囊前肢、右侧内囊后肢、双侧丘脑后辐射、右侧上纵束、双侧上额辐射和左侧额中回的 FA 值降低，MD 值升高（P<0.01）。与 T2DM-NC 患者相比，T2DM-C 患者胼胝体、双侧穹窿、右侧内囊后肢、大脑脚、右侧上纵束、右侧丘脑后辐射和左侧额中回的 FA 值降低，MD 值升高（P<0.01）。
本研究表明，T2DM 患者存在 WM 损伤，可能与微血管并发症有关。更重要的是，本研究还表明，这种损伤可能在临床上可以诊断之前，就可以通过 DTI 模式的功能 MRI 进行诊断。
