Reheman Mariyemuguli, Buch Sagar, He Naying, Huang Pei, Yu Qiurong, Wang Xinhui, Liu Yu, Zhang Youmin, Jin Zhijia, Li Yan, Liu Peng, Chen Shengdi, Haacke E Mark, Yan Fuhua
Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China.
Department of Neurology, Wayne State University, 3990 John R, Detroit, MI, USA.
Neuroimage. 2025 May 15;312:121236. doi: 10.1016/j.neuroimage.2025.121236. Epub 2025 Apr 23.
The pathological relationship between white matter hyperintensities (WMH) and cognitive impairment in Parkinson's disease (PD) remains unclear due to their variable locations, heterogeneity, and limited assessment of underlying tissue properties. This study integrates T2-FLAIR and quantitative MRI (qMRI) to investigate burden, spatial distribution, and extent of tissue alterations in WMH, aiming to elucidate their role in cognitive decline among PD patients.
A total of 122 age- and sex-matched PD patients and 65 healthy controls (HC) were recruited, with PD patients grouped by Montreal Cognitive Assessment (MoCA) score including normal, mild cognitive impairment (MCI) or PD with dementia (PDD). WMH burden was compared across groups and cognitive status. Water content, T1, and T2* measures were derived from qMRI data and tissue property heatmaps and periventricular distance profiles were constructed for all groups to visualize location-dependent tissue alterations of WMH relative to the lateral ventricles. In addition, voxel-wise analysis was performed to examine the correlation between WMH lesion tissue properties and MoCA scores.
WMH volume was significantly higher in PDD compared to other groups (p < 0.05) and negatively correlated with MoCA scores (r = -0.352, p < 0.001). WMH appeared predominantly around the lateral ventricles, with anterior horn involvement common to all groups and posterior horn involvement specific to PDD. qMRI measures were significantly elevated in WMH compared to normal appearing white matter (NAWM) (p < 0.001), with heatmaps showing a negative gradient of tissue property changes from the lateral ventricles to the NAWM. Voxel-wise analysis revealed a significant negative correlation between the qMRI tissue properties of periventricular WMH and MoCA scores, with the strongest association observed in the periventricular WM situated just beyond the boundary of the lateral ventricles.
Over and above volume differences, the spatial distribution and tissue property variations of WMH were closely linked to cognitive impairment in PD patients, with distinct patterns across different cognitive stages.
由于白质高信号（WMH）的位置可变、具有异质性且对潜在组织特性的评估有限，帕金森病（PD）中白质高信号与认知障碍之间的病理关系仍不清楚。本研究整合了T2-FLAIR和定量磁共振成像（qMRI），以研究白质高信号中组织改变的负担、空间分布和范围，旨在阐明它们在PD患者认知衰退中的作用。
共招募了122名年龄和性别匹配的PD患者及65名健康对照（HC），根据蒙特利尔认知评估（MoCA）评分将PD患者分为正常、轻度认知障碍（MCI）或帕金森病痴呆（PDD）组。比较各组间以及不同认知状态下的白质高信号负担。从qMRI数据中得出含水量、T1和T2*测量值，并为所有组构建组织特性热图和脑室周围距离剖面图，以可视化白质高信号相对于侧脑室的位置依赖性组织改变。此外，进行了体素级分析，以检查白质高信号病变组织特性与MoCA评分之间的相关性。
与其他组相比，PDD组的白质高信号体积显著更高（p < 0.05），且与MoCA评分呈负相关（r = -0.352，p < 0.001）。白质高信号主要出现在侧脑室周围，所有组均常见前角受累，而PDD组特定于后角受累。与正常白质（NAWM）相比，白质高信号中的qMRI测量值显著升高（p < 0.001），热图显示从侧脑室到正常白质的组织特性变化呈负梯度。体素级分析显示，脑室周围白质高信号的qMRI组织特性与MoCA评分之间存在显著负相关，在侧脑室边界之外的脑室周围白质中观察到最强的关联。
除了体积差异外，白质高信号的空间分布和组织特性变化与PD患者的认知障碍密切相关，在不同认知阶段呈现出不同模式。
