Department of Radiology, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, 29 Xinglong Lane, Changzhou, 213003, Jiangsu, China.
Department of Nephrology, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China.
Acad Radiol. 2023 Jun;30(6):1047-1055. doi: 10.1016/j.acra.2022.06.019. Epub 2022 Jul 22.
The goal of this study was to investigate the relationship between altered brain micro-structure and function, and cognitive function in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis. Specially, diffusion kurtosis imaging (DKI), the resting-state functional connectivity (FC) algorithm, and the least squares support vector regression machine (LSSVRM) were utilized to conduct our study.
A total of 50 patients and 36 matched healthy controls were prospectively enrolled in our study. All subjects completed the Montreal cognitive assessment scale (MoCA) test. DKI and resting-state functional magnetic resonance imaging were measured. Relationship between DKI parameters, FC, and MoCA scores was evaluated. LSSVRM combined with the whale optimization algorithm (WOA) was used to predict cognitive function scores.
In ESRD patients, altered DKI metrics were identified in 12 brain regions. Furthermore, we observed changes in FC values based on regions of interest (ROIs) in nine brain regions, involved in default mode network (DMN), frontoparietal network (FPN), and the limbic system. Significant correlations among DKI values, FC values, and MoCA scores were found. To some extent, altered FC showed significant correlations with changed DKI parameters. Furthermore, optimized prediction models were applied to more accurately predict the cognitive function associated with ESRD patients.
Micro-structural and functional brain changes were found in ESRD patients, which may account for the onset of cognitive impairment in affected patients. These quantitative parameters combined with our optimized prediction model may be helpful to establish more reliable imaging markers to detect and monitor cognitive impairment associated with ESRD.
本研究旨在探讨终末期肾病（ESRD）维持性血液透析患者脑微观结构和功能改变与认知功能之间的关系。特别地，我们采用扩散峰度成像（DKI）、静息态功能连接（FC）算法和最小二乘支持向量回归机（LSSVRM）来进行研究。
本研究前瞻性纳入了 50 名患者和 36 名匹配的健康对照者。所有受试者均完成蒙特利尔认知评估量表（MoCA）测试。测量 DKI 和静息态功能磁共振成像。评估 DKI 参数、FC 与 MoCA 评分之间的关系。采用鲸鱼优化算法（WOA）与 LSSVRM 相结合的方法预测认知功能评分。
在 ESRD 患者中，我们发现 12 个脑区的 DKI 指标发生了改变。此外，我们观察到基于默认模式网络（DMN）、额顶叶网络（FPN）和边缘系统 9 个脑区的感兴趣区（ROI）的 FC 值发生了变化。DKI 值、FC 值和 MoCA 评分之间存在显著相关性。在一定程度上，改变的 FC 与改变的 DKI 参数显著相关。此外，优化的预测模型可更准确地预测与 ESRD 患者相关的认知功能。
ESRD 患者存在脑微观结构和功能改变，这可能是导致患者认知障碍的原因。这些定量参数结合我们优化的预测模型，可能有助于建立更可靠的成像标志物，以检测和监测与 ESRD 相关的认知障碍。
