title: A Diffusion Tensor Imaging Study on White Matter Abnormalities in Patients with Type 2 Diabetes Using Tract-Based Spatial Statistics.
abstract: Patients with type 2 diabetes mellitus have considerably higher risk of developing cognitive impairment and dementia. WM changes in these patients have been reported. Our aim was to demonstrate that gradual and continuous WM change and the associated cognitive decline in patients with type 2 diabetes mellitus can be captured by DTI parameters, which can be used to complement neuropsychological test scores in identifying patients with type 2 diabetes mellitus with and without mild cognitive impairment.
  
  
  
  Forty-two patients with type 2 diabetes mellitus, divided into a group with mild cognitive impairment (n = 20) and a group with normal cognition (n = 22), were enrolled with age-, sex-, and education-matched healthy controls (n = 26). 3T DTI followed by Tract-Based Spatial Statistics analysis was used to investigate the differences in fractional anisotropy, mean diffusivity, axial diffusivity (λ1), and radial diffusivity (λ23) among the groups. A receiver operating characteristic analysis assessed the performance of DTI parameters for separating the 2 groups with type 2 diabetes mellitus.
  
  
  
  The whole-brain Tract-Based Spatial Statistics analysis revealed that 7.3% and 24.9% of the WM exhibited decreased fractional anisotropy and increased mean diffusivity (P < .05), respectively, between the diabetes mellitus with mild cognitive impairment and the diabetes mellitus with normal cognition groups, while considerably larger WM regions showed fractional anisotropy (36.6%) and mean diffusivity (58.8%) changes between the diabetes mellitus with mild cognitive impairment and the healthy control groups. These changes were caused primarily by an elevated radial diffusivity observed in the patients with diabetes mellitus with mild cognitive impairment. Radial diffusivity also exhibited subtle but statistically significant changes between the diabetes mellitus with normal cognition and the healthy control groups. Analyses on individual fiber tracts showed pronounced fractional anisotropy reduction and mean diffusivity elevation in regions related to cognitive functions. The receiver operating characteristic analysis on the right cingulum (hippocampus) showed that fractional anisotropy produced a larger area under the curve (0.832) than mean diffusivity (0.753) for separating mild cognitive impairment from normal cognition among patients with type 2 diabetes mellitus. When fractional anisotropy was combined with mean diffusivity, the area under the curve was further improved to 0.857.
  
  
  
  DTI parameters can show a substantial difference between patients with type 2 diabetes mellitus with and without mild cognitive impairment, suggesting their potential use as an imaging marker for detecting cognitive decline in patients with type 2 diabetes mellitus. More important, DTI parameters may capture gradual and continuous WM changes that can be associated with early stages of cognitive decline in patients with type 2 diabetes mellitus before they can be diagnosed clinically by using conventional neuropsychological tests.
authors.affiliation: From the Departments of Radiology (Y.X., W.Z.) Center for Magnetic Resonance Research (Y.X., Y.S., M.M.K., K.C., X.J.Z.).
authors.forename: Y
authors.identifier: 0000-0002-6270-5220
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Center for Magnetic Resonance Research (Y.X., Y.S., M.M.K., K.C., X.J.Z.) Bioengineering (Y.S., X.J.Z.).
authors.forename: Y
authors.identifier: 0000-0002-8177-1661
authors.initials: Y
authors.lastname: Sui
authors.affiliation: Department of Pathophysiology (Z.X., J.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Z
authors.identifier: 0000-0002-7324-6664
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Neurology (Q.Z.), Tongji Hospital.
authors.forename: Q
authors.identifier: 0000-0002-5496-170X
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Center for Magnetic Resonance Research (Y.X., Y.S., M.M.K., K.C., X.J.Z.).
authors.forename: M M
authors.identifier: 0000-0002-7080-7307
authors.initials: MM
authors.lastname: Karaman
authors.affiliation: Center for Magnetic Resonance Research (Y.X., Y.S., M.M.K., K.C., X.J.Z.) Departments of Radiology (K.C., T.M.A., X.J.Z.).
authors.forename: K
authors.identifier: 0000-0003-1511-4273
authors.initials: K
authors.lastname: Cai
authors.affiliation: Departments of Radiology (K.C., T.M.A., X.J.Z.).
authors.forename: T M
authors.identifier: 0000-0001-6960-1726
authors.initials: TM
authors.lastname: Anderson
authors.affiliation: From the Departments of Radiology (Y.X., W.Z.).
authors.forename: W
authors.identifier: 0000-0002-0254-6563
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Pathophysiology (Z.X., J.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China xjzhou@uic.edu wangjz@mail.hust.edu.cn.
authors.forename: J
authors.identifier: 0000-0001-8947-6811
authors.initials: J
authors.lastname: Wang
authors.affiliation: Center for Magnetic Resonance Research (Y.X., Y.S., M.M.K., K.C., X.J.Z.) Departments of Radiology (K.C., T.M.A., X.J.Z.) Bioengineering (Y.S., X.J.Z.) Neurosurgery (X.J.Z.), University of Illinois Hospital and Health Sciences System, Chicago, Illinois. xjzhou@uic.edu wangjz@mail.hust.edu.cn.
authors.forename: X J
authors.identifier: 0000-0003-0793-4925
authors.initials: XJ
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology