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Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: A diffusion-tensor study

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this investigation was to examine the association between cognition disorders and microstructural white matter (WM) changes in maintenance hemodialysis end-stage renal disease (ESRD) patients.

Methods

Twenty-six maintenance hemodialysis ESRD patients and 28 healthy controls underwent diffusion tensor imaging (DTI), Mini Mental State Examination (MMSE), Trial Marking Test-A&B (TMT-A&B), and white matter hyperintensity (WMH) assessment. Tract-based spatial statistics (TBSS) analyses was performed to evaluate WM changes in the patients. Relationships between behavioural performances, clinical data, and the DTI index were tested, respectively, by correlation analysis at the voxel level.

Results

ESRD patients showed significant decreased fractional anisotropy (FA) in 14 WM regions, and increased mean diffusivity (MD) and radial diffusivity (RD) in widespread regions. Significant positive correlations between FA values and MMSE scores were found in the right anterior corona radiata and the left anterior thalamic radiation; significant negative correlations between the TMT-B time consumption and FA values were identified in the bilateral superior longitudinal fasciculus. Positive linear relationships between MD, RD values, and the duration of hemodialysis were found in several WM regions.

Conclusion

Structural damages to radiation and associative fibre tracts, caused by brain oedema and WM demyelination, may account for the cognitive deficits in ESRD patients.

Key Points

• Lower FA, higher MD and RD values were found in ESRD patients.

• Cognitive deficits in ESRD patients mainly focused on executive dysfunction.

• Cognitive impairment in ESRD patients may be associated with damages to WM.

• MD and RD are valuable in monitoring WM alteration in ESRD patients.

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Abbreviations

ESRD:

End-stage renal disease

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

MD:

Mean diffusivity

AD:

Axial diffusivity

RD:

Radial diffusivity

MMSE:

Mini Mental State Examination

TMT:

Trial Marking Test

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Acknowledgements

This work was supported by a grant from the China Postdoctoral Science Foundation (Grant No. 2014M552596 for Kai Liu). The scientific guarantor of this publication is Gang Sun. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the China Postdoctoral Science Foundation (Grant No. 2014M552596 for Kai Liu). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained from the ethics committee of Jinan Military General Hospital, and written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Medical Imaging, Jinan Military General Hospital, No.25, Shifan Road, Jinan, Shandong Province, China, 250031

    Ruijie Zhang, Kai Liu, Shaowen Qian, Bo Li, Zhaohui Peng, Min Li, Shengpeng Sang, Qingjun Jiang & Gang Sun

  2. Department of Medical Imaging, Jinan Maternity and Child Care Hospital, No.2, Jianguo Xiaojing 3 Road, Jinan, Shandong Province, China, 250031

    Linfeng Yang

  3. Department of Medical Imaging, Laiwu City People’s Hospital, No.001, Xuehu Street Changshao North Road, Laiwu, Shandong Province, China, 271100

    Tao Zhou

Authors
  1. Ruijie Zhang
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  2. Kai Liu
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  3. Linfeng Yang
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  4. Tao Zhou
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  5. Shaowen Qian
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  8. Min Li
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  10. Qingjun Jiang
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  11. Gang Sun
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Corresponding author

Correspondence to Gang Sun.

Additional information

Ruijie Zhang and Kai Liu contributed equally to this work.

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Zhang, R., Liu, K., Yang, L. et al. Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: A diffusion-tensor study. Eur Radiol 25, 661–668 (2015). https://doi.org/10.1007/s00330-014-3466-5

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  • DOI: https://doi.org/10.1007/s00330-014-3466-5

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