Du Wei, Li Yuan, Jiang Yuhan, Yang Chun, Bao Yimiao, Cao Jiajun, Wang Yilin, Miao Yanwei
Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
Quant Imaging Med Surg. 2025 Jul 1;15(7):6016-6031. doi: 10.21037/qims-24-1692. Epub 2025 Jun 30.
Patients with chronic kidney disease (CKD) tend to have white-matter network and glymphatic system dysfunction, and may experience cognitive decline and psychiatric abnormalities. This study explored the relationships between graph theory-based white-matter networks and diffusion tensor image analysis along the perivascular space (DTI-ALPS) and the choroid plexus volume (CPV).
Sixty-one CKD patients, including 22 non-dialysis dependent (NDD) and 39 dialysis-dependent (DD) patients, and 43 age-, gender-, and education-matched healthy control (HC) participants were recruited for the study. All participants underwent blood biochemical tests, neuropsychological assessments, and magnetic resonance imaging scans. Preprocessed images were used to construct fractional anisotropy networks, and calculate the DTI-ALPS index and CPV. Intergroup comparisons were performed for all measurements, and correlations were analyzed.
Compared to the HCs, the DD-CKD patients had elevated small-worldness (σ) and normalized clustering coefficient (P<0.01) values, while no significant statistical differences were observed between NDD-CKD patients and the HCs. The clustering coefficient (P<0.05), and global and local efficiency (P<0.01) values were decreased, while the characteristic path length (P<0.01) was increased in the CKD patients, especially those who were DD. The CKD patients also had decreased DTI-ALPS index (P=0.001) and increased CPV (P<0.001) values. These indicators were correlated with verbal memory, anxiety, and depression levels (all P<0.05). The mediation analysis revealed that σ partially mediated the effect of the DTI-ALPS index on depression levels (mediation effect: -5.0404), σ fully mediated the effect of the CPV on depression levels (mediation effect: 0.0013), and σ fully mediated the effect of the DTI-ALPS index on anxiety levels (mediation effect: -5.9291).
CKD patients exhibit impaired glymphatic system function and abnormal white-matter network topology, both of which are correlated with cognition, verbal memory, and emotional states. The structural integrity and organizational efficiency of white-matter networks may be a critical factor linking glymphatic dysfunction to emotional health in CKD patients.
慢性肾脏病（CKD）患者往往存在白质网络和脑淋巴系统功能障碍，并可能出现认知能力下降和精神异常。本研究探讨了基于图论的白质网络与沿血管周围间隙的扩散张量图像分析（DTI-ALPS）及脉络丛体积（CPV）之间的关系。
招募了61例CKD患者，包括22例非透析依赖（NDD）患者和39例透析依赖（DD）患者，以及43例年龄、性别和教育程度匹配的健康对照（HC）参与者进行研究。所有参与者均接受了血液生化检查、神经心理学评估和磁共振成像扫描。对预处理后的图像构建分数各向异性网络，并计算DTI-ALPS指数和CPV。对所有测量指标进行组间比较，并分析相关性。
与HCs相比，DD-CKD患者的小世界属性（σ）和标准化聚类系数升高（P<0.01），而NDD-CKD患者与HCs之间未观察到显著统计学差异。CKD患者的聚类系数（P<0.05）、全局和局部效率（P<0.01）值降低，而特征路径长度（P<0.01）增加，尤其是DD患者。CKD患者的DTI-ALPS指数也降低（P=0.001），CPV升高（P<0.001）。这些指标与言语记忆、焦虑和抑郁水平相关（均P<0.05）。中介分析显示，σ部分介导了DTI-ALPS指数对抑郁水平的影响（中介效应：-5.0404），σ完全介导了CPV对抑郁水平的影响（中介效应：0.0013），且σ完全介导了DTI-ALPS指数对焦虑水平的影响（中介效应：-5.9291）。
CKD患者表现出脑淋巴系统功能受损和白质网络拓扑异常，这两者均与认知、言语记忆和情绪状态相关。白质网络的结构完整性和组织效率可能是将CKD患者脑淋巴功能障碍与情绪健康联系起来的关键因素。
