Hou Tingzhou, Wang Yijie, Xu Hanwen, Shu Zhenyu, He Xiaodong, Wu Xiaohong
The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
Front Endocrinol (Lausanne). 2025 May 14;16:1576998. doi: 10.3389/fendo.2025.1576998. eCollection 2025.
Type 2 diabetes mellitus (T2DM) significantly increases the risk of mild cognitive impairment (MCI), and earlier recognition is crucial for timely intervention and improving patients' quality of life.
The aim of this study was to characterize changes in cerebral white matter hyperintensities (WMH) and cerebral blood flow (CBF) based on 3D-arterial spin labeling (3D-ASL) measurements in T2DM with MCI, and to assess their potential as markers for early prediction of MCI.
This study included 30 T2DM patients stratified into T2DM-MCI and T2DM-nMCI groups using MMSE/MoCA. MRI assessed cerebral WMH volume (T2-FLAIR) and regional CBF (3D-ASL) in temporal, parietal, occipital, and hippocampal areas. Group differences in WMH/CBF were analyzed, ROC evaluated CBF's diagnostic efficacy for MCI, and CBF-cognition correlations were assessed via Spearman's analysis.
Cranial MRI analysis shows that there were no significant differences between the two groups in terms of total cerebral WMH volume and regional volume (P>0.05). CBF in the temporal, parietal, occipital, and hippocampal regions was significantly lower in the T2DM-MCI group than in the T2DM-nMCI group (P<0.05). ROC analysis revealed that CBF in the hippocampus had the highest diagnostic efficacy (AUC = 0.813, optimal cutoff value of 41.165 ml/(100 g·min), sensitivity 73.3%, specificity 80.0%). Spearman's correlation analysis showed that CBF in the temporal, parietal, occipital, and hippocampal regions was significantly and positively correlated with MoCA scores (P < 0.05), with temporal and parietal CBF also significantly and positively correlated with MMSE scores (P < 0.05).
CBF, based on 3D-ASL measurements, especially in the hippocampus, is a promising functional marker for identifying MCI in patients with T2DM.
2型糖尿病（T2DM）显著增加轻度认知障碍（MCI）的风险，早期识别对于及时干预和改善患者生活质量至关重要。
本研究旨在基于三维动脉自旋标记（3D-ASL）测量，描述伴MCI的T2DM患者脑白质高信号（WMH）和脑血流量（CBF）的变化，并评估它们作为MCI早期预测标志物的潜力。
本研究纳入30例T2DM患者，使用简易精神状态检查表/蒙特利尔认知评估量表（MMSE/MoCA）将其分为T2DM-MCI组和T2DM-nMCI组。通过磁共振成像（MRI）评估颞叶、顶叶、枕叶和海马区的脑WMH体积（T2-FLAIR）和局部CBF（3D-ASL）。分析WMH/CBF的组间差异，受试者工作特征曲线（ROC）评估CBF对MCI的诊断效能，通过Spearman分析评估CBF与认知的相关性。
头颅MRI分析显示，两组在全脑WMH总体积和局部体积方面无显著差异（P>0.05）。T2DM-MCI组颞叶、顶叶、枕叶和海马区的CBF显著低于T2DM-nMCI组（P<0.05）。ROC分析显示，海马区CBF的诊断效能最高（曲线下面积[AUC]=0.813，最佳截断值为41.165 ml/(100 g·min)，敏感性73.3%，特异性80.0%）。Spearman相关性分析显示，颞叶、顶叶、枕叶和海马区的CBF与MoCA评分显著正相关（P<0.05），颞叶和顶叶的CBF也与MMSE评分显著正相关（P<0.05）。
基于3D-ASL测量的CBF，尤其是海马区的CBF，是识别T2DM患者MCI的一个有前景的功能标志物。
