Aging in deep gray matter and white matter revealed by diffusional kurtosis imaging

Spatiotemporal Patterns of White Matter Maturation after Pre-Adolescence: A Diffusion Kurtosis Imaging Study

Diffusion tensor imaging (DTI) enables the assessment of changes in brain tissue microstructure during maturation and ageing. In general, patterns of cerebral maturation and decline render non-monotonic lifespan trajectories of DTI metrics with age, and, importantly, the rate of microstructural changes is heterochronous for various white matter fibres. Recent studies have demonstrated that diffusion kurtosis imaging (DKI) metrics are more sensitive to microstructural changes during ageing compared to those of DTI. In a previous work, we demonstrated that the Cohen's d of mean diffusional kurtosis (dMK) represents a useful biomarker for quantifying maturation heterochronicity. However, some inferences on the maturation grades of different fibre types, such as association, projection, and commissural, were of a preliminary nature due to the insufficient number of fibres considered. Hence, the purpose of this follow-up work was to further explore the heterochronicity of microstructural maturation between pre-adolescence and middle adulthood based on DTI and DKI metrics. Using the effect size of the between-group parametric changes and Cohen's d, we observed that all commissural fibres achieved the highest level of maturity, followed by the majority of projection fibres, while the majority of association fibres were the least matured. We also demonstrated that dMK strongly correlates with the maxima or minima of the lifespan curves of DTI metrics. Furthermore, our results provide substantial evidence for the existence of spatial gradients in the timing of white matter maturation. In conclusion, our data suggest that DKI provides useful biomarkers for the investigation of maturation spatial heterogeneity and heterochronicity.

White Matter Microstructure Analysis in Subjective Memory Complaints and Cognitive Impairment: Insights from Diffusion Kurtosis Imaging and Free-Water DTI

Background

Dementia is characterized by a cognitive decline in memory and other domains that lead to functional impairments. As people age, subjective memory complaints (SMC) become common, where individuals perceive cognitive decline without objective deficits on assessments. SMC can be an early sign and may precede amnestic mild cognitive impairment (MCI), which frequently advances to Alzheimer's disease (AD).

Objective

This study aims to investigate white matter microstructure in individuals with SMC, in cognitively impaired (CI) cohorts, and in cognitively normal individuals using diffusion kurtosis imaging (DKI) and free water imaging (FWI). The study also explores voxel-based correlations between DKI/FWI metrics and cognitive scores to understand the relationship between brain microstructure and cognitive function.

Methods

Twelve healthy controls (HCs), ten individuals with SMC, and eleven CI individuals (MCI or AD) were enrolled in this study. All participants underwent MRI 3T scan and the BNI Screen (BNIS) for Higher Cerebral Functions.

Results

The mean kurtosis tensor and anisotropy of the kurtosis tensor showed significant differences across the three groups, indicating altered white matter microstructure in CI and SMC individuals. The free water volume fraction (f) also revealed group differences, suggesting changes in extracellular water content. Notably, these metrics effectively discriminated between the CI and HC/SMC groups. Additionally, correlations between imaging metrics and BNIS scores were found for CI and SMC groups.

Conclusions

These imaging metrics hold promise in discriminating between individuals with CI and SMC. The observed differences indicate their potential as sensitive and specific biomarkers for early detection and differentiation of cognitive decline.

Stress-induced red nucleus attenuation induces anxiety-like behavior and lymph node CCL5 secretion

Previous studies have speculated that brain activity directly controls immune responses in lymphoid organs. However, the upstream brain regions that control lymphoid organs and how they interface with lymphoid organs to produce stress-induced anxiety-like behavior remain elusive. Using stressed human participants and rat models, we show that CCL5 levels are increased in stressed individuals compared to controls. Stress-inducible CCL5 is mainly produced from cervical lymph nodes (CLN). Retrograde tracing from CLN identifies glutamatergic neurons in the red nucleus (RN), the activities of which are tightly correlated with CCL5 levels and anxiety-like behavior in male rats. Ablation or chemogenetic inhibition of RN glutamatergic neurons increases anxiety levels and CCL5 expression in the serum and CLNs, whereas pharmacogenetic activation of these neurons reduces anxiety levels and CCL5 synthesis after restraint stress exposure. Chemogenetic inhibition of the projection from primary motor cortex to RN elicits anxiety-like behavior and CCL5 synthesis. This brain-lymph node axis provides insights into lymph node tissue as a stress-responsive endocrine organ.

Brain microstructural alterations in the left precuneus mediate the association between KIBRA polymorphism and working memory in healthy adults: a diffusion kurtosis imaging study

Kidney and brain expressed protein (KIBRA) rs17070145 is associated with working memory function and cognitive processes. However, the neural mechanisms underlying these associations are not fully understood. This study aimed to explore the effect of KIBRA polymorphism on brain microstructure and blood oxygenation level dependent (BOLD) fluctuations using diffusion kurtosis imaging (DKI) and resting-state functional magnetic resonance imaging (fMRI) in 163 young adults. We also investigated that whether the imaging alterations mediated the association between KIBRA gene and working memory performance. Voxel-based analysis of DKI data showed that KIBRA C-allele carriers exhibited increased axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) as well as decreased fractional anisotropy (FA), mean kurtosis (MK) and radial kurtosis (RK) compared with KIBRA TT homozygotes, primarily involving the prefrontal lobe, left precuneus and the left superior parietal white matter. Meanwhile, KIBRA C-allele carriers exhibited decreased amplitude of low-frequency fluctuation (ALFF) in the left precuneus compared to KIBRA TT homozygotes. Mediation analysis revealed that the DKI metrics (MK and RK) of the left precuneus mediated the effect of the KIBRA polymorphism on working memory performance. Moreover, the MK and RK in the left precuneus were positively correlated with ALFF in the same brain region. These findings suggest that abnormal DKI parameters may provide a gene-brain-behavior pathway in which KIBRA rs17070145 affects working memory by modulating brain microstructure in the left precuneus. This illustrates that DKI may provide additional biological information and reveal new insights into the neural mechanisms of the KIBRA polymorphism.

Hippocampal-subfield microstructures and their relation to plasma biomarkers in Alzheimer's disease

Hippocampal subfields exhibit differential vulnerabilities to Alzheimer's disease-associated pathology including abnormal accumulation of amyloid-β deposition and neurofibrillary tangles. These pathological processes extensively impact on the structural and functional interconnectivities of the subfields and may explain the association between hippocampal dysfunction and cognitive deficits. In this study, we investigated the degree of alterations in the microstructure of hippocampal subfields across the clinical continuum of Alzheimer's disease. We applied a grey matter-specific multi-compartment diffusion model (Cortical-Neurite orientation dispersion and density imaging) to understand the differential effects of Alzheimer's disease pathology on the hippocampal subfield microstructure. A total of 119 participants were included in this cross-sectional study. Participants were stratified into three categories, cognitively normal (n = 47), mild cognitive impairment (n = 52), and Alzheimer's disease (n = 19). Diffusion MRI, plasma biomarkers and neuropsychological test scores were used to determine the association between the microstructural integrity and Alzheimer's disease-associated molecular indicators and cognition. For Alzheimer's disease-related plasma biomarkers, we studied amyloid-β, total tau and neurofilament light; for Alzheimer's disease-related neuropsychological tests, we included the Trail Making Test, Rey Auditory Verbal Learning Test, Digit Span and Montreal Cognitive Assessment. Comparisons between cognitively normal subjects and those with mild cognitive impairment showed significant microstructural alterations in the hippocampal cornu ammonis (CA) 4 and dentate gyrus region, whereas CA 1-3 was the most sensitive region for the later stages in the Alzheimer's disease clinical continuum. Among imaging metrics for microstructures, the volume fraction of isotropic diffusion for interstitial free water demonstrated the largest effect size in between-group comparisons. Regarding the plasma biomarkers, neurofilament light appeared to be the most sensitive biomarker for associations with microstructural imaging findings in CA4-dentate gyrus. CA 1-3 was the subfield which had stronger correlations between cognitive performance and microstructural metrics. Particularly, poor performance on the Rey Auditory Verbal Learning Test and Montreal Cognitive Assessment was associated with decreased intracellular volume fraction. Overall, our findings support the value of tissue-specific microstructural imaging for providing pathologically relevant information manifesting in the plasma biomarkers and neuropsychological outcomes across various stages of Alzheimer's disease.

Generalisation of continuous time random walk to anomalous diffusion MRI models with an age-related evaluation of human corpus callosum

Diffusion MRI measures of the human brain provide key insight into microstructural variations across individuals and into the impact of central nervous system diseases and disorders. One approach to extract information from diffusion signals has been to use biologically relevant analytical models to link millimetre scale diffusion MRI measures with microscale influences. The other approach has been to represent diffusion as an anomalous transport process and infer microstructural information from the different anomalous diffusion equation parameters. In this study, we investigated how parameters of various anomalous diffusion models vary with age in the human brain white matter, particularly focusing on the corpus callosum. We first unified several established anomalous diffusion models (the super-diffusion, sub-diffusion, quasi-diffusion and fractional Bloch-Torrey models) under the continuous time random walk modelling framework. This unification allows a consistent parameter fitting strategy to be applied from which meaningful model parameter comparisons can be made. We then provided a novel way to derive the diffusional kurtosis imaging (DKI) model, which is shown to be a degree two approximation of the sub-diffusion model. This link between the DKI and sub-diffusion models led to a new robust technique for generating maps of kurtosis and diffusivity using the sub-diffusion parameters β_SUB and D_SUB. Superior tissue contrast is achieved in kurtosis maps based on the sub-diffusion model. 7T diffusion weighted MRI data for 65 healthy participants in the age range 19-78 years was used in this study. Results revealed that anomalous diffusion model parameters α and β have shown consistent positive correlation with age in the corpus callosum, indicating α and β are sensitive to tissue microstructural changes in ageing.

Combined Application of Quantitative Susceptibility Mapping and Diffusion Kurtosis Imaging Techniques to Investigate the Effect of Iron Deposition on Microstructural Changes in the Brain in Parkinson's Disease

OBJECTIVES

Brain iron deposition and microstructural changes in brain tissue are associated with Parkinson's disease (PD). However, the correlation between these factors in Parkinson's disease has been little studied. This study aimed to use quantitative susceptibility mapping combined with diffusion kurtosis imaging to investigate the effects of iron deposition on microstructural tissue alterations in the brain.

METHODS

Quantitative susceptibility mapping and diffusion kurtosis imaging were performed on 24 patients with early PD, 13 patients with advanced PD, and 25 healthy controls. The mean values of magnetic susceptibility and diffusion kurtosis were calculated for the bilateral substantia nigra, red nucleus, putamen, globus pallidus, and caudate nucleus, and compared between the groups. Correlation analyses between the diffusion kurtosis of each nucleus and its magnetic susceptibility parameters in PD patients and healthy controls were performed.

RESULTS

The study found a significant increase in iron deposition in the substantia nigra, red nucleus, putamen and globus pallidus, bilaterally, in patients with PD. Mean kurtosis values were increased in the substantia nigra but decreased in the globus pallidus; axial kurtosis values were decreased in both the substantia nigra and red nucleus; radial kurtosis values were increased in the substantia nigra but showed an opposite trend in the globus pallidus and caudate nucleus. In the substantia nigra of patients with PD, magnetic susceptibility was positively correlated with mean and radial kurtosis values, and negatively correlated with axial kurtosis. None of these correlations were significantly different in the control group. In the putamen, magnetic susceptibility was positively correlated with mean, axial, and radial kurtosis only in patients with advanced-stage PD.

CONCLUSION

Our study provides new evidence for brain iron content and microstructural alterations in patients with PD. Iron deposition may be a common mechanism for microstructural alterations in the substantia nigra and putamen of patients with PD. Tracking the dynamic changes in iron content and microstructure throughout the course of PD will help us to better understand the dynamics of iron metabolism and microstructural alterations in the pathogenesis of PD and to develop new approaches to monitor and treat PD.

White matter integrity changes and neurocognitive functioning in adult-late onset DM1: a follow-up DTI study

Myotonic Dystrophy Type 1 (DM1) is a multisystemic disease that affects gray and white matter (WM) tissues. WM changes in DM1 include increased hyperintensities and altered tract integrity distributed in a widespread manner. However, the precise temporal and spatial progression of the changes are yet undetermined. MRI data were acquired from 8 adult- and late-onset DM1 patients and 10 healthy controls (HC) at two different timepoints over 9.06 years. Fractional anisotropy (FA) and mean diffusivity (MD) variations were assessed with Tract-Based Spatial Statistics. Transversal and longitudinal intra- and intergroup analyses were conducted, along with correlation analyses with clinical and neuropsychological data. At baseline, reduced FA and increased MD values were found in patients in the uncinate, anterior-thalamic, fronto-occipital, and longitudinal tracts. At follow-up, the WM disconnection was shown to have spread from the frontal part to the rest of the tracts in the brain. Furthermore, WM lesion burden was negatively correlated with FA values, while visuo-construction and intellectual functioning were positively correlated with global and regional FA values at follow-up. DM1 patients showed a pronounced WM integrity loss over time compared to HC, with a neurodegeneration pattern that suggests a progressive anterior–posterior disconnection. The visuo-construction domain stands out as the most sensitive neuropsychological measure for WM microstructural impairment.

Altered Microstructural Changes Detected by Diffusion Kurtosis Imaging in Patients With Cognitive Impairment After Acute Cerebral Infarction

Objective

To detect the microstructural changes in patients with cognitive impairment after acute cerebral infarction using diffusion kurtosis imaging (DKI).

Materials and Methods

A total of 70 patients with acute cerebral infarction were divided into two groups: 35 patients with cognitive impairment (VCI group), and 35 patients without cognitive impairment (N-VCI group), according to mini-mental state examination (MMSE) score. Healthy individuals (n = 36) were selected as the normal control (NORM) group. DKI parameters from 28 different brain regions of interest (ROIs) were selected, measured, and compared.

Results

VCI group patients had significantly higher mean diffusion (MD) and significantly lower mean kurtosis (MK) values in most ROIs than those in the N-VCI and NORM groups. DKI parameters in some ROIs correlated significantly with MMSE score. The splenium of corpus callosum MD was most correlated with MMSE score, the correlation coefficient was −0.652, and this parameter had good ability to distinguish patients with VCI from healthy controls; at the optimal cut-off MD value (0.9915), sensitivity was 91.4%, specificity 100%, and the area under the curve value 0.964.

Conclusions

Pathological changes in some brain regions may underlie cognitive impairment after acute cerebral infarction, especially the splenium of corpus callosum. These preliminary results suggest that, in patients with VCI, DKI may be useful for assessing microstructural tissue damage.

Diffusional Characteristics of Brain Matter after Stroke

We analyzed characteristics of diffusion and its kurtosis obtained using diffusion-kurtosis MRI in the hemisphere contralateral to the one affected by acute cerebrovascular accident. Diffusion characteristics in the white and gray matter were compared using analysis of covariance (ANCOVA) in healthy subjects and stroke patients with consideration for the age and sex factors. Significant differences between the groups were revealed for apparent diffusion coefficient and mean kurtosis in the white matter. Age dependence was studied using regression analysis and, according to the results of ANCOVA, this factor was found to be significant for apparent diffusion coefficient and diffusion kurtosis in the white matter. Metrics are proposed that can be used to determine the risk of stroke.

Fiber Ball White Matter Modeling Reveals Microstructural Alterations in Healthy Brain Aging

Age-related white matter degeneration is characterized by myelin breakdown and neuronal fiber loss that preferentially occur in regions that myelinate later in development. Conventional diffusion MRI (dMRI) has demonstrated age-related increases in diffusivity but provide limited information regarding the tissue-specific changes driving these effects. A recently developed dMRI biophysical modeling technique, Fiber Ball White Matter (FBWM) modeling, offers enhanced biological interpretability by estimating microstructural properties specific to the intra-axonal and extra-axonal spaces. We used FBWM to illustrate the biological mechanisms underlying changes throughout white matter in healthy aging using data from 63 cognitively unimpaired adults ages 45-85 with no radiological evidence of neurodegeneration or incipient Alzheimer's disease. Conventional dMRI and FBWM metrics were computed for two late-myelinating (genu of the corpus callosum and association tracts) and two early-myelinating regions (splenium of the corpus callosum and projection tracts). We examined the associations between age and these metrics in each region and tested whether age was differentially associated with these metrics in late- vs. early-myelinating regions. We found that conventional metrics replicated patterns of age-related increases in diffusivity in late-myelinating regions. FBWM additionally revealed specific intra- and extra-axonal changes suggestive of myelin breakdown and preferential loss of smaller-diameter axons, yielding in vivo corroboration of findings from histopathological studies of aged brains. These results demonstrate that advanced biophysical modeling approaches, such as FBWM, offer novel information about the microstructure-specific alterations contributing to white matter changes in healthy aging. These tools hold promise as sensitive indicators of early pathological changes related to neurodegenerative disease.

Evidence for microscopic kurtosis in neural tissue revealed by correlation tensor MRI

PURPOSE

The impact of microscopic diffusional kurtosis (µK), arising from restricted diffusion and/or structural disorder, remains a controversial issue in contemporary diffusion MRI (dMRI). Recently, correlation tensor imaging (CTI) was introduced to disentangle the sources contributing to diffusional kurtosis, without relying on a-priori multi-gaussian component (MGC) or other microstructural assumptions. Here, we investigated µK in in vivo rat brains and assessed its impact on state-of-the-art methods ignoring µK.

THEORY AND METHODS

CTI harnesses double diffusion encoding (DDE) experiments, which were here improved for speed and minimal bias using four different sets of acquisition parameters. The robustness of the improved CTI protocol was assessed via simulations. In vivo CTI acquisitions were performed in healthy rat brains using a 9.4T pre-clinical scanner equipped with a cryogenic coil, and targeted the estimation of µK, anisotropic kurtosis, and isotropic kurtosis.

RESULTS

The improved CTI acquisition scheme substantially reduces scan time and importantly, also minimizes higher-order-term biases, thus enabling robust µK estimation, alongside K_aniso and K_iso metrics. Our CTI experiments revealed positive µK both in white and gray matter of the rat brain in vivo; µK is the dominant kurtosis source in healthy gray matter tissue. The non-negligible µK substantially were found to bias prior MGC analyses of K_iso and K_aniso .

CONCLUSIONS

Correlation Tensor MRI offers a more accurate and robust characterization of kurtosis sources than its predecessors. µK is non-negligible in vivo in healthy white and gray matter tissues and could be an important biomarker for future studies. Our findings thus have both theoretical and practical implications for future dMRI research.

Proprioceptive Acuity is Enhanced During Arm Movements Compared to When the Arm is Stationary: A Study of Young and Older Adults

Proprioception in old age is thought to be poorer due to degeneration of the central (CNS) and peripheral nervous systems (PNS). We tested whether community-dwelling older adults (65-83 years) make larger proprioceptive errors than young adults (18-22 years) using a natural reaching task. Subjects moved the right arm to touch the index fingertip to the stationary or moving left index fingertip. The range of locations of the target index fingertip was large, sampling the natural workspace of the human arm. The target arm was moved actively by the subject or passively by the experimenter and reaching arm movements towards the target were made under visual guidance, or with vision blocked (proprioceptive guidance). Subjects did not know the direction or speed of upcoming target hand motion in the passive conditions. Mean 3D distance errors between the right and left index finger tips were small in both groups and only slightly larger when vision was blocked than when allowed, but averaged 2-5 mm larger in older than in younger adults in moving (p = 0.002) and stationary (p = 0.07) conditions, respectively. Variable errors were small and similar in the two groups (p > 0.35). Importantly, clearly larger errors were observed for reaching to the stationary than to the moving index fingertip in both groups, demonstrating that dynamic proprioceptive information during movement permits more accurate localization of the endpoint of the moving arm. This novel finding demonstrates the importance of dynamic proprioceptive information in movement guidance and bimanual coordination.

Microstructural and Cerebral Blood Flow Abnormalities in Subjective Cognitive Decline Plus: Diffusional Kurtosis Imaging and Three-Dimensional Arterial Spin Labeling Study

Objective: To explore microstructural and cerebral blood flow (CBF) abnormalities in individuals with subjective cognitive decline plus (SCD plus) using diffusional kurtosis imaging (DKI) and three-dimensional (3D) arterial spin labeling (ASL). Methods: Twenty-seven patients with SCD plus, 31 patients with amnestic mild cognitive impairment (aMCI), and 33 elderly controls (ECs) were recruited and underwent DKI and 3D ASL using a GE 3.0-T MRI. Mean kurtosis (MK), fractional anisotropy (FA), mean diffusivity (MD), and CBF values were acquired from 24 regions of interest (ROIs) in the brain, including the bilateral hippocampal (Hip) subregions (head, body, and tail), posterior cingulate cortex (PCC), precuneus, dorsal thalamus subregions (anterior nucleus, ventrolateral nucleus, and medial nucleus), lenticular nucleus, caput nuclei caudati, white matter (WM) of the frontal lobe, and WM of the occipital lobe. Pearson's correlation analysis was performed to assess the relationships among the DKI-derived parameters, CBF values, and key neuropsychological tests for SCD plus. Results: Compared with ECs, participants with SCD plus showed a significant decline in MK and CBF values, mainly in the Hip head and PCC, and participants with aMCI exhibited more significant abnormalities in the MK and CBF values than individuals with ECs and SCD plus in multiple regions. Combined MK values showed better discrimination between patients with SCD plus and ECs than that obtained using CBF levels, with areas under the receiver operating characteristic (ROC) curve (AUC) of 0.874 and 0.837, respectively. Similarly, the AUC in discriminating SCD plus from aMCI patients obtained using combined MK values was 0.823, which was also higher than the combined AUC of 0.779 obtained using CBF values. Moreover, MK levels in the left Hip (h) and left PCC positively correlated with the auditory verbal learning test-delayed recall (AVLT-DR) score in participants with SCD plus. By contrast, only the CBF value in the left Hip head positively correlated with the AVLT-DR score. Conclusions: Our results provide new evidence of microstructural and CBF changes in patients with SCD plus. MK may be used as an early potential neuroimaging biomarker and may be a more sensitive DKI parameter than CBF at the very early stage of Alzheimer's disease (AD).

Imaging microstructure with diffusion and susceptibility MR: neuronal density correlation in Disrupted-in-Schizophrenia-1 mutant mice

PURPOSE

To probe cerebral microstructural abnormalities and assess changes of neuronal density in Disrupted-in-Schizophrenia-1 (DISC1) mice using non-Gaussian diffusion and quantitative susceptibility mapping (QSM).

MATERIALS AND METHODS

Brain specimens of transgenic DISC1 mice (n = 8) and control mice (n = 7) were scanned. Metrics of neurite orientation dispersion and density imaging (NODDI) and diffusion kurtosis imaging (DKI), as well as QSM, were acquired. Cell counting was performed on Nissl-stained sections. Group differences of imaging metrics and cell density were assessed. Pearson correlations between imaging metrics and cell densities were also examined.

RESULTS

Significant increases of neuronal density were observed in the hippocampus of DISC1 mice. DKI metrics such as mean kurtosis exhibited significant group differences in the caudate putamen (P = 0.015), cerebral cortex (P = 0.021), and hippocampus (P = 0.011). However, DKI metrics did not correlate with cell density. In contrast, significant positive correlation between density of neurons and the neurite density index of NODDI in the hippocampus was observed (r = 0.783, P = 0.007). Significant correlation between density of neurons and susceptibility (r = 0.657, P = 0.039), as well as between density of neuroglia and susceptibility (r = 0.750, P = 0.013), was also observed in the hippocampus.

CONCLUSION

The imaging metrics derived from DKI were not sensitive specifically to cell density, while NODDI could provide diffusion metrics sensitive to density of neurons. The magnetic susceptibility values derived from the QSM method can serve as a sensitive biomarker for quantifying neuronal density.

Associations between age and brain microstructure in older community-dwelling men and women: the Rancho Bernardo Study

Cytoarchitectural brain changes during normal aging remain poorly characterized, and it is unclear whether patterns of brain aging differ by sex. This study used restriction spectrum imaging to examine associations between age and brain microstructure in 147 community-dwelling participants (aged 56-99 years). Widespread associations with age in multiple diffusion compartments, including increased free water, decreased restricted and hindered diffusion, and reduced neurite complexity, were observed in the cortical gray matter, the white matter tracts, and the hippocampus. Age differences in cortical microstructure were largely independent of atrophy. Associations were mostly global, although foci of stronger effects emerged in the fornix, anterior thalamic radiation and commissural fibers, and the medial temporal, orbitofrontal, and occipital cortices. Age differences were stronger and more widespread for women than men, even after adjustment for education, hypertension, and body mass index. Restriction spectrum imaging may be a convenient, noninvasive tool for monitoring changes in diffusion properties that are thought to reflect reduced cellular fractions and neurite density or complexity, which occur with typical aging, and for detecting sex differences in patterns of brain aging.

Diffusion Kurtosis Imaging of Microstructural Changes in Gray Matter Nucleus in Parkinson Disease

Objective: To explore the microstructural damage of extrapyramidal system gray matter nuclei in Parkinson disease (PD) using diffusion kurtosis imaging (DKI). Materials and Methods: We enrolled 35 clinically confirmed PD patients and 23 healthy volunteers. All patients underwent MR examination with conventional MRI scan sequences and an additional DKI sequence. We subsequently reconstructed the DKI raw images and analyzed the data. A radiologist in our hospital collected the Mini-Mental State Examination (MMSE) score of all subjects. Results: In the PD group, the mean kurtosis and axial kurtosis level decreased in the red nucleus (RN) and thalamus; the radial kurtosis increased in the substantia nigra (SN) and globus pallidus (GP). Fractional anisotropy decreased in the putamen. The largest area under the ROC curve of mean diffusion in GP was 0.811. Most kurtosis parameters demonstrated a positive correlation with the MMSE score, while several diffusion parameters showed a negative correlation with the same. Conclusion: DKI can qualitatively distinguish PD from healthy controls; furthermore, DKI-derived parameters can quantitatively evaluate the modifications of microstructures in extrapyramidal system gray matter nucleus in PD.

Regional T1 mapping of the whole cervical spinal cord using an optimized MP2RAGE sequence

The recently-proposed MP2RAGE sequence was purposely optimized for cervical spinal cord imaging at 3T. Sequence parameters were chosen to optimize gray/white matter T₁ contrast with sub-millimetric resolution and scan-time < 10 min while preserving reliable T₁ determination with minimal B₁⁺ variation effects within a range of values compatible with pathologies and surrounding structures. Results showed good agreements with IR-based measurements, high MP2RAGE-based T₁ reproducibility and preliminary evidences of age- and tract-related T₁ variations in the healthy spinal cord.

Detecting normal pediatric brain development with diffusional kurtosis imaging

PURPOSE

To characterise the pattern of change of diffusional kurtosis imaging (DKI) parameters (including kurtosis and diffusion parameters) in both white matter and gray matter in normal brain development with a large sample of subjects from term-born neonates to 14-years old children.

METHODS

Two hundred and eighteen normal children (136 male, 82 female) underwent conventional magnetic resonance imaging and DKI. Regions of interest (ROIs) were placed in 7 white matter areas and 4 gray matter areas. Then the DKI-derived parameters were automatically calculated, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity (Dr), mean kurtosis (MK), axial kurtosis (Ka) and radial kurtosis (Kr). The correlation between the DKI parameters and ages were analyzed using nonlinear fit, and the rate of parameter change was computed compared to the baseline value of the neonates.

RESULTS

For all ROIs in the white matter and gray matter, the FA, MK, Kr, Ka values increased with age, while the MD and Dr values decreased with age. The correlations were good to excellent, which changed rapidly within the first 2 years and relatively slowly after 2 years. The Da values in peripheral white matters and some gray matter structures (caudate nucleus and putamen) decreased with age. The amplitude of kurtosis parameters variation was greater than that of the diffusion parameters in both white matter and gray matter.

CONCLUSIONS

The DKI parameters correlated well with age, and kurtosis parameters showed a potential advantage in detecting the normal brain development of children.

Differences between normal and diabetic brains in middle-aged rats by MRI

Normal aging is a risk factor for metabolic disorders such as diabetes, and diabetes is also a recognized cause of accelerated aging. Being able to distinguish changes caused by normal aging from those caused by diabetes, would provide insight into how the aging brain interacts with diabetes. Eight types of MRI metric maps (magnetization relaxation time constants of T₁ and T₂, cerebral blood flow, cerebrovascular permeability, mean diffusivity, diffusion fractional anisotropy, mean diffusion kurtosis and diffusion directional entropy) were generated for all rats from the three groups of normal young, healthy and 1.5-month diabetic middle-aged rats under investigation. Measurements of multiple MRI indices of cerebral white and gray matter from animals of the three groups provide complementary results and insight into differences between healthy and diabetic white / gray matter in the mid-aged rats. Our data indicate that MRI may distinguish between the normal and diabetes in mid-aged rat brains by measuring either T₁ and T₂ of gray matter, or fractional anisotropy of white matter and gray matter. Therefore, MRI can distinguish changes of cerebral tissue due to the normal aging from diabetic aging, which may lead to be able to better understand how diabetes accelerates aging in normal brain.

Microstructural white matter alterations associated to neurocognitive deficits in childhood leukemia survivors treated with cranial radiotherapy - a diffusional kurtosis study

Background: Cranial radiotherapy (CRT) is a known risk factor for neurocognitive impairment in survivors of childhood acute lymphoblastic leukemia (ALL). Diffusion tensor imaging (DTI) and diffusional kurtosis imaging (DKI) are MRI techniques that quantify microstructural changes in brain white matter (WM) and DKI is regarded as the more sensitive of them. Our aim was to more thoroughly understand the nature of cognitive deficits after cranial radiotherapy (CRT) in adulthood after childhood ALL. Material and methods: Thirty-eight (21 women) ALL survivors, median age 38 (27-46) years, were investigated at median 34 years after diagnosis. All had been treated with a CRT dose of 24 Gy and with 11 years of complete hormone supplementation. DTI and DKI parameters were determined and neurocognitive tests were performed in ALL survivors and 29 matched controls. Results: ALL survivors scored lower than controls in neurocognitive tests of vocabulary, memory, learning capacity, spatial ability, executive functions, and attention (p < .001). The survivors had altered DTI parameters in the fornix, uncinate fasciculus, and ventral cingulum (all p < .05) and altered DKI parameters in the fornix, uncinate fasciculus, and dorsal and ventral cingulum (p < .05). Altered DTI parameters in the fornix were associated with impaired episodic verbal memory (r = -0.40, p < .04). The left and right uncinate fasciculus (r = 0.6, p < .001), (r = -0.5, p < .02) as well as the right ventral cingulum (r = 0.5, p < .007) were associated with impaired episodic visual memory. Altered DKI parameters in the fornix, right uncinate fasciculus (r = 0.3, r = 0.05, p = .02), and ventral cingulum (r = 0.3, p = .02) were associated with impaired results of episodic visual memory. Conclusion: ALL survivors with cognitive deficits demonstrated microstructural damage in several WM tracts that were more extensive with DKI as compared to DTI; this might be a marker of radiation and chemotherapy neurotoxicity underlying cognitive dysfunction.

Diffusion MRI detects longitudinal white matter changes in the 3xTg-AD mouse model of Alzheimer's disease

The sensitivity of multiple diffusion MRI (dMRI) parameters to longitudinal changes in white matter microstructure was investigated for the 3xTg-AD transgenic mouse model of Alzheimer's disease, which manifests both amyloid beta plaques and neurofibrillary tangles. By employing a specific dMRI method known as diffusional kurtosis imaging, eight different diffusion parameters were quantified to characterize distinct aspects of water diffusion. Four female 3xTg-AD mice were imaged at five time points, ranging from 4.5 to 18 months of age, and the diffusion parameters were investigated in four white matter regions (fimbria, external capsule, internal capsule and corpus callosum). Significant changes were observed in several diffusion parameters, particularly in the fimbria and in the external capsule, with a statistically significant decrease in diffusivity and a statistically significant increase in kurtosis. Our preliminary results demonstrate that dMRI can detect microstructural changes in white matter for the 3xTg-AD mouse model due to aging and/or progression of pathology, depending strongly on the diffusion parameter and anatomical region.

The Conjoint Analysis of Microstructural and Morphological Changes of Gray Matter During Aging

Macromorphological and microstructural changes of gray matter (GM) happen during brain normal aging. However, the mechanism of macro-microstructure association is still unclear, which is of guidance for understanding many neurodegenerative diseases. In this study, adopting structural magnetic resonance imaging (sMRI) and diffusion kurtosis imaging (DKI), GM aging pattern was characterized and its macro-microstructure associations were revealed. For 60 subjects among the ages of 47-79, the DKI and T1-weighted images were investigated with voxel-based analysis. The results showed age-related overlapped patterns between morphological and microstructural alterations during normal aging. It was worth noting that morphological changes and mean diffusivity (MD) indexes abnormalities mainly overlapped in the following regions, superior frontal gyrus, inferior frontal gyrus, cingulum gyrus, superior temporal gyrus, insula, and thalamus. Besides, overlapped with GM atrophies, mean kurtosis (MK) abnormalities were observed in superior frontal gyrus, inferior frontal gyrus, transverse temporal gyrus, insula, and thalamus. What important was that intrinsic aging independent associations between macrostructure and microstructure were found especially in media superior frontal gyrus, which revealed the potential mechanisms in the process of aging. The physiological mechanism may be associated with the elimination of neurons and synapses and the shrinkage of large neurons. Understanding the associations of GM volume changes and microstructural changes can account for the underlying mechanisms of aging and age-related neurodegenerative diseases.

Age-related microstructural and physiological changes in normal brain measured by MRI γ-metrics derived from anomalous diffusion signal representation

Nowadays, increasing longevity associated with declining cerebral nervous system functions, suggests the need for continued development of new imaging contrast mechanisms to support the differential diagnosis of age-related decline. In our previous papers, we developed a new imaging contrast metrics derived from anomalous diffusion signal representation and obtained from diffusion-weighted (DW) data collected by varying diffusion gradient strengths. Recently, we highlighted that the new metrics, named γ-metrics, depended on the local inhomogeneity due to differences in magnetic susceptibility between tissues and diffusion compartments in young healthy subjects, thus providing information about myelin orientation and iron content within cerebral regions. The major structural modifications occurring in brain aging are myelinated fibers damage in nerve fibers and iron accumulation in gray matter nuclei. Therefore, we investigated the potential of γ-metrics in relation to other conventional diffusion metrics such as DTI, DKI and NODDI in detecting age-related structural changes in white matter (WM) and subcortical gray matter (scGM). DW-images were acquired in 32 healthy subjects, adults and elderly (age range 20-77 years) using 3.0T and 12 b-values up to 5000 s/mm². Association between diffusion metrics and subjects' age was assessed using linear regression. A decline in mean γ (Mγ) in the scGM and a complementary increase in radial γ (γ_⊥) in frontal WM, genu of corpus callosum and anterior corona radiata with advancing age were found. We suggested that the increase in γ⊥ might reflect declined myelin density, and Mγ decrease might mirror iron accumulation. An increase in D_// and a decrease in the orientation dispersion index (ODI) were associated with axonal loss in the pyramidal tracts, while their inverted trends within the thalamus were thought to be linked to reduced architectural complexity of nerve fibers. γ-metrics together with conventional diffusion-metrics can more comprehensively characterize the complex mechanisms underlining age-related changes than conventional diffusion techniques alone.

Modeling white matter tract integrity in aging with diffusional kurtosis imaging

Myelin breakdown and neural fiber loss occur in aging. This study used white matter tract integrity metrics derived from biophysical modeling using Diffusional Kurtosis Imaging to assess loss of myelin (i.e., extraaxonal diffusivity, radial direction, De,⊥) and axonal density (i.e., axonal water fraction) in cognitively unimpaired older adults. Tract-based spatial statistics and region of interest analyses sought to identify ontogenic differences and age-related changes in white matter tracts using cross-sectional and longitudinal data analyzed with general linear and mixed-effects models. In addition to pure diffusion parameters (i.e., fractional anisotropy, mean diffusivity, mean kurtosis), we found that white matter tract integrity metrics significantly differentiated early- from late-myelinating tracts, correlated with age in spatially distinct regions, and identified primarily extraaxonal changes over time. Percent metric changes were |0.3-0.9|% and |0.0-1.9|% per year using cross-sectional data and longitudinal data, respectively. There was accelerated decline in some late- versus early-myelinating tracts in older age. These results demonstrate that these metrics may inform further study of the transition from age-related changes to neurodegenerative decline.

Microstructural alterations of cortical and deep gray matter over a season of high school football revealed by diffusion kurtosis imaging

OBJECTIVES

To probe microstructural changes that are associated with subconcussive head impact exposure in deep and cortical gray matter of high school football players over a single season.

METHODS

Players underwent diffusion kurtosis imaging (DKI) and quantitative susceptibility mapping (QSM) scans. Head impact data was recorded. Association between parametric changes and frequency of frontal head impact was assessed.

RESULTS

In deep gray matter, significant decreases in mean kurtosis (MK) and increases in mean diffusivity (MD) over the season were observed in the thalamus and putamen. Correlations between changes in DKI metrics and frequency of frontal impacts were observed in the putamen and caudate. In cortical gray matter, decreases in MK were observed in regions including the pars triangularis and inferior parietal. In addition, increases in MD were observed in the rostral middle frontal cortices. Negative correlations between MK and frequency of frontal impacts were observed in the posterior part of the brain including the pericalcarine, lingual and middle temporal cortices. Magnetic susceptibility values exhibited no significant difference or correlation, suggesting these diffusion changes common within the group may not be associated with iron-related mechanisms.

CONCLUSION

Microstructural alterations over the season and correlations with head impacts were captured by DKI metrics, which suggested that DKI imaging of gray matter may yield valuable biomarkers for evaluating brain injuries associated with subconcussive head impact. Findings of associations between frontal impacts and changes in posterior cortical gray matter also indicated that contrecoup injury rather than coup injury might be the dominant mechanism underlying the observed microstructural alterations.

ADVANCES IN KNOWLEDGE

Significant microstructural changes, as reflected by DKI metrics, in cortical gray matter such as the rostral middle frontal cortices, and in deep gray matter such as the thalamus were observed in high school football players over the course of a single season without clinically diagnosed concussion. QSM showed no evidence of iron-related changes in the observed subconcussive brain injuries. The detected microstructural changes in cortical and deep gray matter correlated with frequency of subconcussive head impacts.

IMPLICATIONS FOR PATIENT CARE

DKI may yield valuable biomarkers for evaluating the severity of brain injuries associated with subconcussive head impacts in contact sport athletes.

White matter biomarkers from fast protocols using axially symmetric diffusion kurtosis imaging

White matter tract integrity (WMTI) can characterize brain microstructure in areas with highly aligned fiber bundles. Several WMTI biomarkers have now been validated against microscopy and provided promising results in studies of brain development and aging, as well as in a number of brain disorders. Currently, WMTI is mostly used in dedicated animal studies and clinical studies of slowly progressing diseases, and has not yet emerged as a routine clinical tool. To this end, a less data intensive experimental method would be beneficial by enabling high resolution validation studies, and ease clinical applications by speeding up data acquisition compared with typical diffusion kurtosis imaging (DKI) protocols utilized as part of WMTI imaging. Here, we evaluate WMTI based on recently introduced axially symmetric DKI, which has lower data demand than conventional DKI. We compare WMTI parameters derived from conventional DKI with those calculated analytically from axially symmetric DKI. We employ numerical simulations, as well as data from fixed rat spinal cord (one sample) and in vivo human (three subjects) and rat brain (four animals). Our analysis shows that analytical WMTI based on axially symmetric DKI with sparse data sets (19 images) produces WMTI metrics that correlate strongly with estimates based on traditional DKI data sets (60 images or more). We demonstrate the preclinical potential of the proposed WMTI technique in in vivo rat brain (300 μm isotropic resolution with whole brain coverage in a 1 h acquisition). WMTI parameter estimates are subject to a duality leading to two solution branches dependent on a sign choice, which is currently debated. Results from both of these branches are presented and discussed throughout our analysis. The proposed fast WMTI approach may be useful for preclinical research and e.g. clinical evaluation of patients with traumatic white matter injuries or symptoms of neurovascular or neuroinflammatory disorders.

Automated detection of pathologic white matter alterations in Alzheimer's disease using combined diffusivity and kurtosis method

Diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) are important diffusion MRI techniques for detecting microstructure abnormities in diseases such as Alzheimer's. The advantages of DKI over DTI have been reported generally; however, the indistinct relationship between diffusivity and kurtosis has not been clearly revealed in clinical settings. In this study, we hypothesize that the combination of diffusivity and kurtosis in DKI improves the capacity of DKI to detect Alzheimer's disease compared with diffusivity or kurtosis alone. Specifically, a support vector machine-based approach was applied to combine diffusivity and kurtosis and to compare different indices datasets. Strict assessments were conducted to ensure the reliability of all classifiers. Then, data from the optimized classifiers were used to detect abnormalities. With the combination, high accuracy performances of 96.23% were obtained in 53 subjects, including 27 Alzheimer's patients. More highly scored abnormal regions were selected by the combination than alone. The results revealed that more precise diffusivity and complementary kurtosis mainly contributed to the high performance of the combination in DKI. This study provides further understanding of DKI and the relationship between diffusivity and kurtosis in pathologic white matter alterations in Alzheimer's disease.

Evaluating kurtosis-based diffusion MRI tissue models for white matter with fiber ball imaging

In order to quantify well-defined microstructural properties of brain tissue from diffusion MRI (dMRI) data, tissue models are typically employed that relate biological features, such as cell morphology and cell membrane permeability, to the diffusion dynamics. A variety of such models have been proposed for white matter, and their validation is a topic of active interest. In this paper, three different tissue models are tested by comparing their predictions for a specific microstructural parameter to a value measured independently with a recently proposed dMRI method known as fiber ball imaging (FBI). The three tissue models are all constructed with the diffusion and kurtosis tensors, and they are hence compatible with diffusional kurtosis imaging. Nevertheless, the models differ significantly in their details and predictions. For voxels with fractional anisotropies (FAs) exceeding 0.5, all three are reasonably consistent with FBI. However, for lower FA values, one of these, called the white matter tract integrity (WMTI) model, is found to be in much better accord with FBI than the other two, suggesting that the WMTI model has a broader range of applicability.

Differential microstructural and morphological abnormalities in mild cognitive impairment and Alzheimer's disease: Evidence from cortical and deep gray matter

One aim of this study is to use non-Gaussian diffusion kurtosis imaging (DKI) for capturing microstructural abnormalities in gray matter of Alzheimer's disease (AD). The other aim is to compare DKI metrics against thickness of cortical gray matter and volume of deep gray matter, respectively. A cohort of 18 patients with AD, 18 patients with amnestic mild cognitive impairment (MCI), and 18 normal controls underwent morphological and DKI MR imaging. Images were investigated using regions-of-interest-based analyses for deep gray matter and vertex-wise analyses for cortical gray matter. In deep gray matter, more regions showed DKI parametric abnormalities than atrophies at the early MCI stage. Mean kurtosis (MK) exhibited the largest number of significant abnormalities among all DKI metrics. At the later AD stage, diffusional abnormalities were observed in fewer regions than atrophies. In cortical gray matter, abnormalities in thickness were mainly in the medial and lateral temporal lobes, which fit the locations of known early pathological changes. Microstructural abnormalities were predominantly in the parietal and even frontal lobes, which fit the locations of known late pathological changes. In conclusion, MK can complement conventional diffusion metrics for detecting microstructural changes, especially in deep gray matter. This study also provides evidence supporting the notion that microstructural changes predate morphological changes. Hum Brain Mapp 38:2495-2508, 2017. © 2017 Wiley Periodicals, Inc.

Non-Gaussian Diffusion Imaging Shows Brain Myelin and Axonal Changes in Obstructive Sleep Apnea

OBJECTIVE

Obstructive sleep apnea (OSA) is accompanied by brain changes in areas that regulate autonomic, cognitive, and mood functions, which were initially examined by Gaussian-based diffusion tensor imaging measures, but can be better assessed with non-Gaussian measures. We aimed to evaluate axonal and myelin changes in OSA using axial (AK) and radial kurtosis (RK) measures.

MATERIALS AND METHODS

We acquired diffusion kurtosis imaging data from 22 OSA and 26 controls; AK and RK maps were calculated, normalized, smoothed, and compared between groups using analysis of covariance.

RESULTS

Increased AK, indicating axonal changes, emerged in the insula, hippocampus, amygdala, dorsolateral pons, and cerebellar peduncles and showed more axonal injury over previously identified damage. Higher RK, showing myelin changes, appeared in the hippocampus, amygdala, temporal and frontal lobes, insula, midline pons, and cerebellar peduncles and showed more widespread myelin damage over previously identified injury.

CONCLUSIONS

Axial kurtosis and RK measures showed widespread changes over Gaussian-based techniques, suggesting a more sensitive nature of kurtoses to injury.

Exploring the origins of echo-time-dependent quantitative susceptibility mapping (QSM) measurements in healthy tissue and cerebral microbleeds

Quantitative susceptibility mapping (QSM) is increasingly used to measure variation in tissue composition both in the brain and in other areas of the body in a range of disease pathologies. Although QSM measurements were originally believed to be independent of the echo time (TE) used in the gradient-recalled echo (GRE) acquisition from which they are derived; recent literature (Sood et al., 2016) has shown that these measurements can be highly TE-dependent in a number of brain regions. In this work we systematically investigate possible causes of this effect through analysis of apparent frequency and QSM measurements derived from data acquired at multiple TEs in vivo in healthy brain regions and in cerebral microbleeds (CMBs); QSM data acquired in a gadolinium-doped phantom; and in QSM data derived from idealized simulated phase data. Apparent frequency measurements in the optic radiations (OR) and central corpus callosum (CC) were compared to those predicted by a 3-pool white matter model, however the model failed to fully explain contrasting frequency profiles measured in the OR and CC. Our results show that TE-dependent QSM measurements can be caused by a failure of phase unwrapping algorithms in and around strong susceptibility sources such as CMBs; however, in healthy brain regions this behavior appears to result from intrinsic non-linear phase evolution in the MR signal. From these results we conclude that care must be taken when deriving frequency and QSM measurements in strong susceptibility sources due to the inherent limitations in phase unwrapping; and that while signal compartmentalization due to tissue microstructure and content is a plausible cause of TE-dependent frequency and QSM measurements in healthy brain regions, better sampling of the MR signal and more complex models of tissue are needed to fully exploit this relationship.

Classification of Cognitive Level of Patients with Leukoaraiosis on the Basis of Linear and Non-Linear Functional Connectivity

Leukoaraiosis (LA) describes diffuse white matter abnormalities apparent in computed tomography (CT) or magnetic resonance (MR) brain scans. Patients with LA generally show varying degrees of cognitive impairment, which can be classified as cognitively normal (CN), mild cognitive impairment (MCI), and dementia. However, a consistent relationship between the degree of LA and the level of cognitive impairment has not yet been established. We used functional magnetic resonance imaging (fMRI) to explore possible neuroimaging biomarkers for classification of cognitive level in LA. Functional connectivity (FC) between brain regions was calculated using Pearson’s correlation coefficient (PCC), maximal information coefficient (MIC), and extended maximal information coefficient (eMIC). Next, FCs with high discriminative power for different cognitive levels in LA were used as features for classification based on support vector machine. CN and MCI were classified with accuracies of 75.0, 61.9, and 91.1% based on features from PCC, MIC, and eMIC, respectively. MCI and dementia were classified with accuracies of 80.1, 86.2, and 87.4% based on features from PCC, MIC, and eMIC, respectively. CN and dementia were classified with accuracies of 80.1, 89.9, and 94.4% based on features from PCC, MIC, and eMIC, respectively. Our results suggest that features extracted from fMRI were efficient for classification of cognitive impairment level in LA, especially, when features were based on a non-linear method (eMIC).

The γ-parameter of anomalous diffusion quantified in human brain by MRI depends on local magnetic susceptibility differences

Motivated by previous results obtained in vitro, we investigated the dependence of the anomalous diffusion (AD) MRI technique on local magnetic susceptibility differences (Δχ) driven by magnetic field inhomogeneity in human brains. The AD-imaging contrast investigated here is quantified by the stretched-exponential parameter γ, extracted from diffusion weighted (DW) data collected by varying diffusion gradient strengths. We performed T₂* and DW experiments in eight healthy subjects at 3.0T. T₂*-weighted images at different TEs=(10,20,35,55)ms and DW-EPI images with fourteen b-values from 0 to 5000s/mm² were acquired. AD-metrics and Diffusion Tensor Imaging (DTI) parameters were compared and correlated to R₂* and to Δχ values taken from literature for the gray (GM) and the white (WM) matter. Pearson's correlation test and Analysis of Variance with Bonferroni post-hoc test were used. Significant strong linear correlations were found between AD γ-metrics and R₂* in both GM and WM of the human brain, but not between DTI-metrics and R₂*. Depending on Δχ driven magnetic field inhomogeneity, the new contrast provided by AD-γ imaging reflects Δχ due to differences in myelin orientation and iron content within selected regions in the WM and GM, respectively. This feature of the AD-γ imaging due to the fact that γ is quantified by using MRI, may be an alternative strategy to investigate, at high magnetic fields, microstructural changes in myelin, and alterations due to iron accumulation. Possible clinical applications might be in the field of neurodegenerative diseases.

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

Myofascial pain, presented as myofascial trigger points (MTrPs)-related pain, is a common, chronic disease involving skeletal muscle, but its underlying mechanisms have been poorly understood. Previous studies have revealed that chronic pain can induce microstructural abnormalities in the cerebral gray matter. However, it remains unclear whether the brain gray matters of patients with chronic MTrPs-related pain undergo alteration. In this study, we employed the Diffusion Kurtosis Imaging (DKI) technique, which is particularly sensitive to brain microstructural perturbation, to monitor the MTrPs-related microstructural alterations in brain gray matter of patients with chronic pain. Our results revealed that, in comparison with the healthy controls, patients with chronic myofascial pain exhibited microstructural abnormalities in the cerebral gray matter and these lesions were mainly distributed in the limbic system and the brain areas involved in the pain matrix. In addition, we showed that microstructural abnormalities in the right anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) had a significant negative correlation with the course of disease and pain intensity. The results of this study demonstrated for the first time that there are microstructural abnormalities in the brain gray matter of patients with MTrPs-related chronic pain. Our findings may provide new insights into the future development of appropriate therapeutic strategies to this disease.

Changes in brain iron concentration after exposure to high-altitude hypoxia measured by quantitative susceptibility mapping

Hypoxia can induce physiological changes. This study aims to explore effects of high-altitude (HA) hypoxia on cerebral iron concentration. Twenty-nine healthy sea-level participants were tested shortly before and after approximately 4-week adaptation to the HA environment at fQinghai-Tibet Plateau (4200m), and were re-investigated after re-adaptation to the sea-level environment one year later. Iron concentration was quantified with quantitative susceptibility mapping (QSM), and the results were compared with transverse relaxation rate (R^*₂) measurements. The variations of magnetic susceptibility indicate that the iron concentration in gray matter regions, especially in basal ganglia, including caudate nucleus, putamen, globus pallidus and substantia nigra, increases significantly after HA exposure. This increase appears consistent with the conclusion from R^*₂ value variations. However, unlike QSM, the R^*₂ value fails to demonstrate the statistical difference of iron content in red nucleus. The re-investigation results show that most variations are recovered after sea-level re-adaptation for one year. Additionally, hemisphere- and gender-related differences in iron concentration changes were analyzed among cerebral regions. The results show greater possibilities in the right hemisphere and females. Further studies based on diffusion tensor imaging (DTI) suggest that the fractional anisotropy increases and the mean diffusivity decreases after HA exposure in six deep gray matter nuclei, with linear dependence on iron concentration only in putamen. In conclusion, the magnetic susceptibility value can serve as a quantitative marker of brain iron, and variations of regional susceptibility reported herein indicate that HA hypoxia can result in significant iron deposition in most deep gray matter regions. Additionally, the linear dependence of DTI metrics on iron concentration in putamen indicates a potential relationship between ferritin and water diffusion.

Characteristics of Diffusional Kurtosis in Chronic Ischemia of Adult Moyamoya Disease: Comparing Diffusional Kurtosis and Diffusion Tensor Imaging

BACKGROUND AND PURPOSE

Detecting microstructural changes due to chronic ischemia potentially enables early identification of patients at risk of cognitive impairment. In this study, diffusional kurtosis imaging and diffusion tensor imaging were used to investigate whether the former provides additional information regarding microstructural changes in the gray and white matter of adult patients with Moyamoya disease.

MATERIALS AND METHODS

MR imaging (diffusional kurtosis imaging and DTI) was performed in 23 adult patients with Moyamoya disease and 23 age-matched controls. Three parameters were extracted from diffusional kurtosis imaging (mean kurtosis, axial kurtosis, and radial kurtosis), and 4, from DTI (fractional anisotropy, radial diffusivity, mean diffusivity, and axial diffusivity). Voxelwise analysis for these parameters was performed in the normal-appearing brain parenchyma. The association of these parameters with neuropsychological performance was also evaluated.

RESULTS

Voxelwise analysis revealed the greatest differences in fractional anisotropy, followed, in order, by radial diffusivity, mean diffusivity, and mean kurtosis. In patients, diffusional kurtosis imaging parameters were decreased in the dorsal deep white matter such as the corona radiata and superior longitudinal fasciculus (P < .01), including areas without DTI abnormality. Superior longitudinal fasciculus fiber-crossing areas showed weak correlations between diffusional kurtosis imaging and DTI parameters compared with tissues with a single-fiber direction (eg, the corpus callosum). Diffusional kurtosis imaging parameters were associated with general intelligence and frontal lobe performance.

CONCLUSIONS

Although DTI revealed extensive white matter changes, diffusional kurtosis imaging additionally demonstrated microstructural changes in ischemia-prone deep white matter with abundant fiber crossings. Thus, diffusional kurtosis imaging may be a useful adjunct for detecting subtle chronic ischemic injuries.

Tract-specific and age-related variations of the spinal cord microstructure: a multi-parametric MRI study using diffusion tensor imaging (DTI) and inhomogeneous magnetization transfer (ihMT)

Being able to finely characterize the spinal cord (SC) microstructure and its alterations is a key point when investigating neural damage mechanisms encountered in different central nervous system (CNS) pathologies, such as multiple sclerosis, amyotrophic lateral sclerosis or myelopathy. Based on novel methods, including inhomogeneous magnetization transfer (ihMT) and dedicated SC probabilistic atlas post-processing, the present study focuses on the in vivo characterization of the healthy SC tissue in terms of regional microstructure differences between (i) upper and lower cervical vertebral levels and (ii) sensory and motor tracts, as well as differences attributed to normal aging. Forty-eight healthy volunteers aged from 20 to 70 years old were included in the study and scanned at 3 T using axial high-resolution T2 *-w imaging, diffusion tensor imaging (DTI) and ihMT, at two vertebral levels (C2 and C5). A processing pipeline with minimal user intervention, SC segmentation and spatial normalization into a reference space was implemented in order to assess quantitative morphological and structural parameters (cross-sectional areas, scalar DTI and MT/ihMT metrics) in specific white and gray matter regions of interest. The multi-parametric MRI metrics collected allowed upper and lower cervical levels to be distinguished, with higher ihMT ratio (ihMTR), higher axial diffusivity (λ∥ ) and lower radial diffusivity (λ⊥ ) at C2 compared with C5. Significant differences were also observed between white matter fascicles, with higher ihMTR and lower λ∥ in motor tracts compared with posterior sensory tracts. Finally, aging was found to be associated with significant metric alterations (decreased ihMTR and λ∥ ). The methodology proposed here, which can be easily transferred to the clinic, provides new insights for SC characterization. It bears great potential to study focal and diffuse SC damage in neurodegenerative and demyelinating diseases. Copyright © 2016 John Wiley & Sons, Ltd.

Memory and hippocampal architecture following short-term midazolam in western diet-treated rats

The impact of short-term benzodiazepine exposure on cognition in middle-aged or older patients is a highly debated topic among anesthesiologists, critical care physicians and public media. "Western diet" (WD) consumption is linked to impaired cognition as well. The combination of benzodiazepines with substantial exposure to WD might set the stage for increased hippocampal vulnerability for benzodiazepines leading to exaggerated cognitive impairment in the postoperative period. In this study, Fischer 344 rats were fed either WD or standard rodent diet from 5 to 10.5 months of age. Rats were exposed to midazolam or placebo two days prior to an MRI scan using Diffusional Kurtosis Imaging (DKI) to assess brain microstructural integrity, followed by behavioral testing using a water radial arm maze. Hippocampal tissue was collected to assess alterations in protein biochemistry in brain regions associated with learning and memory. Our results showed that rats exposed to the combination of midazolam and WD had significantly delayed time of learning and exhibited spatial memory impairment. Further, we observed an overall increase of kurtosis metrics in the hippocampus and increased expression of the mitochondrial protein VDAC2 in midazolam-treated rats. Our data suggest that both the short-acting benzodiazepine midazolam and WD contribute to negatively affect the brain in middle-aged rats. This study is the first application of DKI on the effects of midazolam and WD exposure, and the findings demonstrate that diffusion metrics are sensitive indicators of changes in the complexity of neurite architecture.

Lower serum osteocalcin concentrations are associated with brain microstructural changes and worse cognitive performance

OBJECTIVE

Rodent models have found that osteocalcin crosses the blood-brain barrier and regulates behaviour. No data are available on osteocalcin's effects on brain microstructure and cognitive performance in humans. We evaluated the association between serum osteocalcin concentrations and (i) brain microstructural changes on magnetic resonance imaging (MRI) and (ii) neuropsychological performance.

DESIGN, PATIENTS AND MEASUREMENTS

We studied 24 consecutive obese subjects (13 women; age, 49·8 ± 8·1 years; body mass index [BMI], 43·9 ± 4·54 kg/m(2) ) and 20 healthy volunteers (10 women; age, 48·8 ± 9·5 years; BMI, 24·3 ± 3·54 kg/m(2) ) in a cross-sectional study within the multicentre FLORINASH Project. FLAIR signal intensity and DTI-metrics (primary (λ1 ), secondary (λ2 ) and tertiary (λ3 ) eigenvalues; fractional anisotropy (FA); and mean diffusivity) in the caudate, hypothalamus, thalamus and putamen, and in subcortical white matter were assessed. Cognitive performance evaluated by neuropsychological test battery.

RESULTS

Lower osteocalcin concentrations were associated with BMI, higher λ1, λ2 and λ3 values at the caudate and lower FLAIR signal intensity at the caudate and putamen. Obese patients with lower osteocalcin concentrations had higher FA at putamen and thalamus. Lower osteocalcin concentrations were associated with higher Iowa Gambling Task (IGT) scores. FLAIR signal intensity at the caudate <601·832 yielded 85·7% sensitivity, 64·3% specificity, 70·6% negative predictive value and 81·8% positive predictive value for IGT score. Lower osteocalcin was an independent predictor of worse cognitive performance on multivariate analysis (F = 3·551, P = 0·01343; R(2) = 0·103). Bayesian information criterion demonstrated that osteocalcin had the predominant role in predicting IGT score.

CONCLUSIONS

Lower serum osteocalcin concentrations are associated with brain microstructural changes and worse cognitive performance.

Monotonic non-linear transformations as a tool to investigate age-related effects on brain white matter integrity: A Box-Cox investigation

Non-linear effects of age on white matter integrity are ubiquitous in the brain and indicate that these effects are more pronounced in certain brain regions at specific ages. Box-Cox analysis is a technique to increase the log-likelihood of linear relationships between variables by means of monotonic non-linear transformations. Here we employ Box-Cox transformations to flexibly and parsimoniously determine the degree of non-linearity of age-related effects on white matter integrity by means of model comparisons using a voxel-wise approach. Analysis of white matter integrity in a sample of adults between 20 and 89years of age (n=88) revealed that considerable portions of the white matter in the corpus callosum, cerebellum, pallidum, brainstem, superior occipito-frontal fascicle and optic radiation show non-linear effects of age. Global analyses revealed an increase in the average non-linearity from fractional anisotropy to radial diffusivity, axial diffusivity, and mean diffusivity. These results suggest that Box-Cox transformations are a useful and flexible tool to investigate more complex non-linear effects of age on white matter integrity and extend the functionality of the Box-Cox analysis in neuroimaging.

Lower cognitive performance and white matter changes in testicular cancer survivors 10 years after chemotherapy

OBJECTIVE

Chemotherapy (CT) is associated with adverse effects on cognition. Only few studies have investigated cognition in testicular cancer (TC) patients and studies on very late effects of CT on cognition are absent. Further, brain changes in relation to treatment have not been investigated in TC. The objective of the present study is to compare psychosocial functioning, cognitive performance and brain (micro)structure following surgery and CT for TC, against surgery (S)-only.

METHODS

Twenty-eight CT (43.1±7.5 y) and 23 S-only (48.2±9.5y) TC survivors on average 14 yr post-treatment were examined using questionnaires, neurocognitive tests, and 3T-MRI [Diffusion Kurtosis Imaging (DKI), T1-weighted and Fluid Attenuated Inversion Recovery]. A multivariate cognitive performance score (Mahalanobis distance) was calculated to indicate the grade of cognitive performance. Kurtosis parameters, gray matter, and white matter (WM) volume were calculated from MRI data.

RESULTS

Overall, the CT group showed lower cognitive performance (5.35±1.7) compared with the S-only group (4.4±0.9; P=0.03; d=0.70). Further, TC patients reported more memory problems after CT. DKI revealed a significantly higher radial kurtosis after CT in several anterior and posterior brain areas (P<0.05, corrected), but this was unrelated to cognitive performance.

CONCLUSIONS

This cross-sectional study suggests that men receiving CT for TC are at risk for long-term lower cognitive performance. Although CT affected WM microstructure, this was unrelated to cognitive performance. More extensive, preferably prospective studies are warranted to confirm these results and to provide more insight into the possible mechanisms behind the observed cognitive sequelae after treatment for TC.

Hemisphere, gender and age-related effects on iron deposition in deep gray matter revealed by quantitative susceptibility mapping

The purpose of this work was to investigate the effects of hemispheric location, gender and age on susceptibility value, as well as the association between susceptibility value and diffusional metrics, in deep gray matter. Iron content was estimated in vivo using quantitative susceptibility mapping. Microstructure was probed using diffusional kurtosis imaging. Regional susceptibility and diffusional metrics were measured for the putamen, caudate nucleus, globus pallidus, thalamus, substantia nigra and red nucleus in 42 healthy adults (age range 25-78 years). Susceptibility value was significantly higher in the left than the right side of the caudate nucleus (P = 0.043) and substantia nigra (P < 0.001). Women exhibited lower susceptibility values than men in the thalamus (P < 0.001) and red nucleus (P = 0.032). Significant age-related increases of susceptibility were observed in the putamen (P < 0.001), red nucleus (P < 0.001), substantia nigra (P = 0.004), caudate nucleus (P < 0.001) and globus pallidus (P = 0.017). The putamen exhibited the highest rate of iron accumulation with aging (slope of linear regression = 0.73 × 10(-3) ppm/year), which was nearly twice those in substantia nigra (slope = 0.40 × 10(-3) ppm/year) and caudate nucleus (slope = 0.39 × 10(-3) ppm/year). Significant positive correlations between the susceptibility value and diffusion measurements were observed for fractional anisotropy (P = 0.045) and mean kurtosis (P = 0.048) in the putamen without controlling for age. Neither correlation was significant after controlling for age. Hemisphere, gender and age-related differences in iron measurements were observed in deep gray matter. Notably, the putamen exhibited the highest rate of increase in susceptibility with aging. Correlations between susceptibility value and microstructural measurements were inconclusive. These findings could provide new clues for unveiling mechanisms underlying iron-related neurodegenerative diseases.