title: Altered brain microstructure assessed by diffusion tensor imaging in patients with diabetes and gastrointestinal symptoms.
abstract: OBJECTIVE
  In patients with long-standing diabetes mellitus (DM), there is increasing evidence for abnormal processing of gastrointestinal sensations in the central nervous system. Using magnetic resonance diffusion tensor imaging, we characterized brain microstructure in areas involved in visceral sensory processing and correlated these findings to clinical parameters.
  
  
  METHODS
  Twenty-six patients with DM and gastrointestinal symptoms and 23 healthy control subjects were studied in a 3T scanner. The apparent diffusion coefficient (i.e., diffusivity of water) and fractional anisotropy (FA) (i.e., organization of fibers) were assessed in the "sensory matrix" (cingulate cortex, insula, prefrontal and secondary sensory cortex, amygdala, and corona radiata) and in corpus callosum.
  
  
  RESULTS
  Patients had decreased FA values compared with control subjects in 1) all areas (P = 0.025); 2) anterior (P < 0.001), mid- (P = 0.001), and posterior (P < 0.001) cingulate cortex; 3) prefrontal cortex gray matter (P < 0.001); 4) corona radiata (P < 0.001); 5) secondary sensory cortex (P = 0.008); and 6) anterior white matter (P = 0.045), anterior gray matter (P = 0.002), and posterior gray matter (P = 0.002) insula. No difference was found in corpus callosum (P > 0.05). The microstructural changes in some areas correlated with clinical parameters such as bloating (anterior insula), mental well-being (anterior insula, prefrontal cortex, and mid-cingulated and corona radiata), autonomic function based on electrocardiographic results (posterior insula and anterior cingulate), and presence of gastroparesis (anterior insula).
  
  
  CONCLUSIONS
  The findings of this explorative study indicate that microstructural changes of brain areas involved in visceral sensory processing are associated with autonomic dysfunction and therefore may be involved in the pathogenesis of gastrointestinal symptoms in DM patients.
authors.affiliation: Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark. jf@mech-sense.com
authors.forename: Jens Brøndum
authors.initials: JB
authors.lastname: Frøkjær
authors.forename: Lars Wiuff
authors.initials: LW
authors.lastname: Andersen
authors.forename: Christina
authors.initials: C
authors.lastname: Brock
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.forename: Maria
authors.initials: M
authors.lastname: Ljungberg
authors.forename: Eirik
authors.initials: E
authors.lastname: Søfteland
authors.forename: Georg
authors.initials: G
authors.lastname: Dimcevski
authors.forename: Yousef
authors.initials: Y
authors.lastname: Yavarian
authors.forename: Hans
authors.initials: H
authors.lastname: Gregersen
authors.forename: Asbjørn Mohr
authors.initials: AM
authors.lastname: Drewes
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D003920:Diabetes Mellitus / Q000473:pathology*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000473:pathology*; D006801:Humans; D008875:Middle Aged