DTI-ALPS index as a predictor of glymphatic system dysfunction in cerebral infarction.

OBJECTIVES

To evaluate glymphatic system (GS) dysfunction in patients with cerebral infarction using diffusion tensor imaging - along the perivascular space (DTI-ALPS), and to investigate factors associated with glymphatic function impairment following stroke.

METHODS

A retrospective study was conducted on 82 patients diagnosed with cerebral infarction at Zhujiang Hospital of Southern Medical University between July 2019 and June 2022. Based on 90-day modified Rankin Scale (mRS) scores, patients were categorized into a good prognosis group (n = 40) and a poor prognosis group (n = 42). Clinical data, National Institutes of Health Stroke Scale (NIHSS) scores, DTI-ALPS indices (L-ALPS, R-ALPS, mean-ALPS), 90-day mRS scores, and infarct location were compared between groups.

RESULTS

At admission, the L-ALPS, R-ALPS, and mean-ALPS values were significantly higher in the good prognosis group compared to the poor prognosis group (all P < 0.05). At 90 days post-onset, Hamilton Depression (HAMD) and Anxiety (HAMA) scores were significantly lower than baseline in the good prognosis group, indicating better psychological recovery compared to the poor prognosis group (both P < 0.05). Additionally, NIHSS scores were lower, while Glasgow Coma Scale (GCS) and activities of daily living (ADL) scores were higher in the good prognosis group (both P < 0.05). Logistic regression analysis identified L-ALPS, R-ALPS, mean-ALPS, 90-day mRS, ADL, and GCS scores as independent predictors of poor prognosis. Furthermore, ADL, 90-day mRS, and GCS scores were independently associated with GS dysfunction.

CONCLUSION

Patients with poor prognosis after cerebral infarction exhibit significant GS dysfunction. This dysfunction correlates with the severity of neurological impairment, suggesting that glymphatic impairment is both a marker and a potential contributor to stroke outcomes.