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Li W, Sun W, Wang D, Jiao Z, Liu T, Zhang W, Shi H. Abnormal Functional Attributes of Central Executive Network in Patients with Mild Cognitive Impairment Associated with End-Stage Renal Disease. Acad Radiol 2024:S1076-6332(24)00462-8. [PMID: 39089906 DOI: 10.1016/j.acra.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
RATIONALE AND OBJECTIVES To assess changes in the central executive network (CEN) of patients with mild cognitive impairment (MCI) associated with end-stage renal disease (ESRD). METHODS A total of 121 patients with ESRD and 66 healthy controls (HCs) were enrolled. Patients were divided into an MCI group (n = 67) and a cognitively unimpaired group (n = 54). All participants underwent resting-state functional magnetic resonance imaging and were evaluated using the Montreal Cognitive Assessment (MoCA). The functional attributes of the CEN were calculated using three methods of functional connectivity (FC) analysis. Relationships among imaging features, cognitive scale scores, and clinical data were assessed, and a model was constructed to diagnose MCI in patients with ESRD. RESULTS The comparison of the three groups showed that there were significant differences in the FC values of five connection pairs within the CEN, and the CEN demonstrated significant differences in connectivity to ten brain regions. In patients with MCI associated with ESRD, the information transmission efficiency of the CEN was reduced, which demonstrates the characteristics of a random network to some extent. Significant correlations were observed among imaging parameters, cognitive scale scores, and clinical data. The diagnostic model constructed based on these results demonstrated excellent discrimination and calibration. CONCLUSION Alterations in the function of the CEN provide relevant bases for revealing the neuropathological mechanism of MCI in patients with ESRD. The diagnostic model developed in this study may help to establish more reliable imaging markers for detecting early cognitive impairment in this patient population.
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Affiliation(s)
- Wenqing Li
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou 213000, China
| | - Wei Sun
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou 213000, China; Graduate College, Dalian Medical University, Dalian 116085, China
| | - Di Wang
- Department of Nephrology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou 213000, China; Graduate College, Dalian Medical University, Dalian 116085, China
| | - Zhuqing Jiao
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213000, China
| | - Tongqiang Liu
- Department of Nephrology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou 213000, China
| | - Wanchao Zhang
- Department of Radiology, The People's Hospital of Wuqia, Xinjiang 845450, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou 213000, China.
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Sun W, Li C, Jiao Z, Liu T, Shi H. Multiparameter neuroimaging study of neurovascular coupling changes in patients with end-stage renal disease. Brain Behav 2024; 14:e3598. [PMID: 38923330 PMCID: PMC11196241 DOI: 10.1002/brb3.3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To assess changes in neurovascular coupling (NVC) by evaluating the relationship between cerebral perfusion and brain connectivity in patients with end-stage renal disease (ESRD) undergoing hemodialysis versus in healthy control participants. And by exploring brain regions with abnormal NVC associated with cognitive deficits in patients, we aim to provide new insights into potential preventive and therapeutic interventions. MATERIALS AND METHODS A total of 45 patients and 40 matched healthy controls were prospectively enrolled in our study. Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. Arterial spin labeling (ASL) was used to calculate cerebral blood flow (CBF), and graph theory-based analysis of results from resting-state functional magnetic resonance imaging (rs-fMRI) was used to calculate brain network topological parameters (node betweenness centrality [BC], node efficiency [Ne], and node degree centrality [DC]). Three NVC biomarkers (CBF-BC, CBF-Ne, and CBF-DC coefficients) at the whole brain level and 3 NVC biomarkers (CBF/BC, CBF/Ne, and CBF/DC ratios) at the local brain region level were used to assess NVC. Mann-Whitney U tests were used to compare the intergroup differences in NVC parameters. Spearman's correlation analysis was used to evaluate the relationship among NVC dysfunctional pattern, cognitive impairment, and clinical characteristics multiple comparisons were corrected using a voxel-wise false-discovery rate (FDR) method (p < .05). RESULTS Patients showed significantly reduced global coupling coefficients for CBF-Ne (p = .023) and CBF-BC (p = .035) compared to healthy controls. Coupling ratios at the local brain region level were significantly higher in patients in 33 brain regions (all p values < .05). Coupling ratio changes alone or accompanied by changes in CBF, node properties, or both CBF and node properties were identified. In patients, negative correlations were seen between coupling ratios and MoCA scores in many brain regions, including the left dorsolateral superior frontal gyrus, the bilateral median cingulate and paracingulate gyri, and the right superior parietal gyrus. The correlations remained even after adjusting for hemoglobin and hematocrit levels. CONCLUSION Disrupted NVC may be one mechanism underlying cognitive impairment in dialysis patients.
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Affiliation(s)
- Wei Sun
- Department of RadiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical UniversityChangzhouChina
- Graduate College, Dalian Medical UniversityDalianChina
| | - Chen Li
- Graduate College, Dalian Medical UniversityDalianChina
- Department of NephrologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical UniversityChangzhouChina
| | - Zhuqing Jiao
- School of Computer Science and Artificial IntelligenceChangzhou UniversityChangzhouJiangsuChina
| | - Tongqiang Liu
- Department of NephrologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical UniversityChangzhouChina
| | - Haifeng Shi
- Department of RadiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical UniversityChangzhouChina
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Yang W, Li M, Song L, Xu B, Chen Q, Yang Z, Liu W, Zhang A, Wang H, Wang ZC. Reduced functional connectivity induced by longitudinal alterations of structure and perfusion may be associated with cognitive impairment in patients on maintenance hemodialysis. Brain Imaging Behav 2024:10.1007/s11682-024-00897-4. [PMID: 38822207 DOI: 10.1007/s11682-024-00897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/02/2024]
Abstract
Hemodialysis (HD) leads to cognitive impairment; however, the pathophysiology of maintenance HD remains unclear. This study aimed to investigate the longitudinal alterations in gray matter volume (GMV) and cerebral blood flow (CBF) in patients on HD at follow-up compared with baseline, examine the alterations in functional connectivity (FC) by defining co-changed brain regions as seed points, and investigate the correlation between the co-changed brain regions and neuropsychological test scores. Twenty-seven patients with HD and 30 healthy controls were enrolled in this study. All participants underwent high-resolution T1-weighted imaging, arterial spin labeling, and functional MR imaging to measure GMV, CBF, and FC. The patients on HD were assessed at baseline and 3 years subsequently. The right and left medial superior frontal gyrus (SFGmed.L) exhibited significantly lower GMV and CBF in patients on HD at follow-up compared with baseline and lower FC between the SFGmed.L and left middle temporal gyrus (MTG.L). FC between the SFGmed.L and MTG.L was positively correlated with neuropsychological test scores in the HD group at follow-up. Reduced GMV and CBF may result in decreased FC between the SFGmed.L and MTG.L, which may be associated with cognitive impairment in patients on maintenance HD. Our findings provide unique insights into the pathological mechanisms of patients on maintenance HD with cognitive impairment.
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Affiliation(s)
- Wenbo Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China
| | - Mingan Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China
| | - Lijun Song
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China
| | - Boyan Xu
- MR Research, GE Healthcare, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China.
| | - Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China.
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, 100050, Beijing, China.
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Liu Y, Wang H, Sha G, Cao Y, Chen Y, Chen Y, Zhang J, Chai C, Fan Q, Xia S. The covariant structural and functional neuro-correlates of cognitive impairments in patients with end-stage renal diseases. Front Neurosci 2024; 18:1374948. [PMID: 38686326 PMCID: PMC11056510 DOI: 10.3389/fnins.2024.1374948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Cognitive impairment (CI) is a common complication of end-stage renal disease (ESRD) that is associated with structural and functional changes in the brain. However, whether a joint structural and functional alteration pattern exists that is related to CI in ESRD is unclear. Methods In this study, instead of looking at brain structure and function separately, we aim to investigate the covariant characteristics of both functional and structural aspects. Specifically, we took the fusion analysis approach, namely, multimodal canonical correlation analysis and joint independent component analysis (mCCA+jICA), to jointly study the discriminative features in gray matter volume (GMV) measured by T1-weighted (T1w) MRI, fractional anisotropy (FA) in white matter measured by diffusion MRI, and the amplitude of low-frequency fluctuation (ALFF) measured by blood oxygenation-level-dependent (BOLD) MRI in 78 ESRD patients versus 64 healthy controls (HCs), followed by a mediation effect analysis to explore the relationship between neuroimaging findings, cognitive impairments and uremic toxins. Results Two joint group-discriminative independent components (ICs) were found to show covariant abnormalities across FA, GMV, and ALFF (all p < 0.05). The most dominant joint IC revealed associative patterns of alterations of GMV (in the precentral gyrus, occipital lobe, temporal lobe, parahippocampal gyrus, and hippocampus), alterations of ALFF (in the precuneus, superior parietal gyrus, and superior occipital gyrus), and of white matter FA (in the corticospinal tract and inferior frontal occipital fasciculus). Another significant IC revealed associative alterations of GMV (in the dorsolateral prefrontal and orbitofrontal cortex) and FA (in the forceps minor). Moreover, the brain changes identified by FA and GMV in the above-mentioned brain regions were found to mediate the negative correlation between serum phosphate and mini-mental state examination (MMSE) scores (all p < 0.05). Conclusion The mCCA+jICA method was demonstrated to be capable of revealing covariant abnormalities across neuronal features of different types in ESRD patients as contrasted to HCs, and joint brain changes may play an important role in mediating the relationship between serum toxins and CIs in ESRD. Our results show the mCCA+jICA fusion analysis approach may provide new insights into similar neurobiological studies.
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Affiliation(s)
- Yuefan Liu
- Department of Biomedical Engineering, Medical College, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
- Haihe Laboratory of Brain-Computer Interaction and Human-Machine Integration, Tianjin, China
| | - Huiying Wang
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Guanchen Sha
- Department of Biomedical Engineering, Medical College, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
- Haihe Laboratory of Brain-Computer Interaction and Human-Machine Integration, Tianjin, China
| | - Yutong Cao
- Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
- Haihe Laboratory of Brain-Computer Interaction and Human-Machine Integration, Tianjin, China
- Intelligent Medical Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yuanyuan Chen
- Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
- Haihe Laboratory of Brain-Computer Interaction and Human-Machine Integration, Tianjin, China
- Intelligent Medical Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Jingyi Zhang
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Chao Chai
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Qiuyun Fan
- Department of Biomedical Engineering, Medical College, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
- Haihe Laboratory of Brain-Computer Interaction and Human-Machine Integration, Tianjin, China
- Intelligent Medical Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Shuang Xia
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, China
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Zhao F, Lv K, Ye S, Chen X, Chen H, Fan S, Mao N, Ren Y. Integration of temporal & spatial properties of dynamic functional connectivity based on two-directional two-dimensional principal component analysis for disease analysis. PeerJ 2024; 12:e17078. [PMID: 38618569 PMCID: PMC11011592 DOI: 10.7717/peerj.17078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/19/2024] [Indexed: 04/16/2024] Open
Abstract
Dynamic functional connectivity, derived from resting-state functional magnetic resonance imaging (rs-fMRI), has emerged as a crucial instrument for investigating and supporting the diagnosis of neurological disorders. However, prevalent features of dynamic functional connectivity predominantly capture either temporal or spatial properties, such as mean and global efficiency, neglecting the significant information embedded in the fusion of spatial and temporal attributes. In addition, dynamic functional connectivity suffers from the problem of temporal mismatch, i.e., the functional connectivity of different subjects at the same time point cannot be matched. To address these problems, this article introduces a novel feature extraction framework grounded in two-directional two-dimensional principal component analysis. This framework is designed to extract features that integrate both spatial and temporal properties of dynamic functional connectivity. Additionally, we propose to use Fourier transform to extract temporal-invariance properties contained in dynamic functional connectivity. Experimental findings underscore the superior performance of features extracted by this framework in classification experiments compared to features capturing individual properties.
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Affiliation(s)
- Feng Zhao
- School of Computer Science and Technology, Shandong Technology and Business University, Yantai, China
| | - Ke Lv
- School of Computer Science and Technology, Shandong Technology and Business University, Yantai, China
| | - Shixin Ye
- School of Computer Science and Technology, Shandong Technology and Business University, Yantai, China
| | - Xiaobo Chen
- School of Computer Science and Technology, Shandong Technology and Business University, Yantai, China
| | - Hongyu Chen
- School Hospital, Shandong Technology and Business University, Yantai, China
| | - Sizhe Fan
- Canada Qingdao Secondary School (CQSS), Qingdao, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yande Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Hu R, Gao L, Chen P, Wei X, Wu X, Xu H. Macroscale neurovascular coupling and functional integration in end-stage renal disease patients with cognitive impairment: A multimodal MRI study. J Neurosci Res 2024; 102:e25277. [PMID: 38284834 DOI: 10.1002/jnr.25277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
End-stage renal disease (ESRD) is associated with vascular and neuronal dysfunction, causing neurovascular coupling (NVC) dysfunction, but how NVC dysfunction acts on the mechanism of cognitive impairment in ESRD patients from local to remote is still poorly understood. We recruited 48 ESRD patients and 35 demographically matched healthy controls to scan resting-state functional MRI and arterial spin labeling, then investigated the four types of NVC between amplitude of low-frequency fluctuation (ALFF), fractional ALFF, regional homogeneity, degree centrality, and cerebral blood perfusion (CBF), and associated functional networks. Our results indicated that ESRD patients showed NVC dysfunction in global gray matter and multiple brain regions due to the mismatch between CBF and neural activity, and associated disrupted functional connectivity (FC) within sensorimotor network (SMN), visual network (VN), default mode network (DMN), salience network (SN), and disrupted FC between them with limbic network (LN), while increased FC between SMN and DMN. Anemia may affect the NVC of middle occipital gyrus and precuneus, and increased pulse pressure may result in disrupted FC with SMN. The NVC dysfunction of the right precuneus, middle frontal gyrus, and parahippocampal gyrus and the FC between the right angular gyrus and the right anterior cingulate gyrus may reflect cognitive impairment in ESRD patients. Our study confirmed that ESRD patients may exist NVC dysfunction and disrupted functional integration in SMN, VN, DMN, SN and LN, serving as one of the mechanisms of cognitive impairment. Anemia and increased pulse pressure may be related risk factors.
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Affiliation(s)
- Runyue Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peina Chen
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Nephrology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Xiaobao Wei
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Nephrology, Lianyungang No 1 People's Hospital, Lianyungang, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Liu P, Luo B, Feng Y, Chen L, Zhao YL, Wang QX, Liang SP, Wu HY, Yuan G, Jiang GH, Zhang J. Aberrant spontaneous brain activity in patients with thyroid-associated ophthalmopathy with and without optic neuropathy: a resting-state functional MRI study. Eur Radiol 2023; 33:7981-7991. [PMID: 37410107 DOI: 10.1007/s00330-023-09829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To investigate the brain functional alterations in dysthyroid optic neuropathy (DON) by evaluating spontaneous neural activity, using functional magnetic resonance imaging (fMRI) with regional homogeneity (ReHo), and its relationship with ophthalmologic performance. METHODS Forty-seven patients with thyroid-associated ophthalmopathy (TAO; 20 with DON, 27 with non-DON) and 33 age-, sex-, and education-matched healthy controls (HCs) underwent fMRI. ReHo values were compared using one-way analysis of variance (ANOVA) with post hoc pairwise comparisons (voxel-level p < 0.01, Gaussian random field correction, cluster-level p < 0.05). Correlations between ReHo values and ophthalmological metrics were assessed for DONs, with Bonferroni correction for multiple comparisons (p < 0.004). ROC curves were applied to evaluate the diagnostic performance of ReHo metrics. RESULTS ReHo values were significantly lower in the left insula and right superior temporal gyrus, and higher in the left posterior cingulate cortex (LPCC), of DON than of non-DON patients. ReHo values were also significantly lower in the right middle temporal, left insula, and left precentral gyrus in DON than in HCs. Meanwhile, ReHo values were higher in LPCC in non-DON than in HCs. ReHo values correlated with ophthalmic examinations to varying degrees in DON. For distinguishing DON, the ReHo values in LPCC showed optimal individually (AUC = 0.843), the combination of the ReHo in both the left insula and LPCC performed better (AUC = 0.915). CONCLUSION Spontaneous brain activity differed between TAO with and without DON, which may reflect the underlying pathological mechanism of DON. The ReHo index can be considered a diagnostic biomarker. CLINICAL RELEVANCE STATEMENT Spontaneous brain activity in DON differed from that in TAO without DON, which may reflect the underlying pathological mechanism of DON. The ReHo index can be considered a diagnostic biomarker for early detection of DON. KEY POINTS • Dysthyroid optic neuropathy (DON) affects brain activity, which contributes in the understanding of its visual dysfunction. • Regional homogeneity values differ between thyroid-associated ophthalmopathy with and without DON in various brain regions. • Regional homogeneity values can be used as a biomarker in the differential diagnosis of DON.
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Affiliation(s)
- Ping Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, #1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Ban Luo
- Department of Ophthalmology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Ying Feng
- Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, China
| | - Lang Chen
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, #1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Ya-Li Zhao
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, #1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Qiu-Xia Wang
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, #1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Si-Pei Liang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Hong-Yu Wu
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, #1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Gang Yuan
- Department of Endocrinology and Metabolism, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Gui-Hua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jing Zhang
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, #1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China.
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Yu Z, Pang H, Liu Y, Li X, Bu S, Wang J, Zhao M, Ren K. Disrupted network communication predicts mild cognitive impairment in end-stage renal disease: an individualized machine learning study based on resting-state fMRI. Cereb Cortex 2023; 33:10098-10107. [PMID: 37492012 DOI: 10.1093/cercor/bhad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
End-Stage Renal Disease (ESRD) is known to be associated with a range of brain injuries, including cognitive decline. The purpose of this study is to investigate the functional connectivity (FC) of the resting-state networks (RSNs) through resting state functional magnetic resonance imaging (MRI), in order to gain insight into the neuropathological mechanism of ESRD. A total of 48 ESRD patients and 49 healthy controls underwent resting-state functional MRI and neuropsychological tests, for which Independent Components Analysis and graph-theory (GT) analysis were utilized. With the machine learning results, we examined the connections between RSNs abnormalities and neuropsychological test scores. Combining intra/inter network FC differences and GT results, ESRD was optimally distinguished in the testing dataset, with a balanced accuracy of 0.917 and area under curve (AUC) of 0.942. Shapley additive explanations results revealed that the increased functional network connectivity between DMN and left frontoparietal network (LFPN) was the most critical predictor for ESRD associated mild cognitive impairment diagnosis. Moreover, hypoSN (salience network) was positively correlated with Attention scores, while hyperLFPN was negatively correlated with Execution scores, indicating correlations between functional disruption and cognitive impairment measurements in ESRD patients. This study demonstrated that both the loss of FC within the SN and compensatory FC within the lateral frontoparietal network coexist in ESRD. This provides a network basis for understanding the individual brain circuits and offers additional noninvasive evidence to comprehend the brain networks in ESRD.
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Affiliation(s)
- Ziyang Yu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Huize Pang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yu Liu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaolu Li
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuting Bu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Juzhou Wang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Mengwan Zhao
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ke Ren
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Xue Y, Wu Z, Li B, Sun G, Jia F, Liu K. Changes in Cerebral Blood Flow in Patients Who Receive Different Durations of Hemodialysis: An Arterial Spin Labeling MRI Study. J Clin Neurol 2023; 19:438-446. [PMID: 37455502 PMCID: PMC10471545 DOI: 10.3988/jcn.2022.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the changes in cerebral blood flow (CBF) in patients who received different durations of hemodialysis (HD) using arterial spin labeling magnetic resonance imaging. METHODS The study included 46 patients who received HD and 24 demographically similar healthy controls (HCs). Patients who received HD were divided into three subgroups based on its duration: HD-1 (n=15, dialysis duration ≤24 months), HD-2 (n=16, dialysis duration >24 and ≤72 months), and HD-3 (n=15, dialysis duration ≥73 months). All subjects completed the Mini Mental State Examination and Montreal Cognitive Assessment tests, and the patients who received HD underwent laboratory tests. Group-level differences in the global and regional CBFs between patients who received HD and HCs were assessed. Correlation analysis was performed to evaluate the associations among CBF, clinical variables, and cognitive function. RESULTS Compared with HCs, global and regional CBFs were significantly increased in the HD-1 and HD-2 groups (p<0.05), but there was no significant difference in the HD-3 group (p>0.05). However, compared with the HD-1 group, the HD-3 group had significantly decreased global and regional CBFs (p<0.05). The cognitive function was worse in patients who received long-term HD than in HCs. Increased dialysis duration and hemoglobin level were predictive risk factors for decreased CBF in patients who received long-term HD. CONCLUSIONS Patients who received long-term HD with normal CBF had worse cognitive function, which may be related to increased dialysis duration.
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Affiliation(s)
- Yan Xue
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhuanzhuan Wu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bo Li
- Department of Radiological Diagnosis, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China
| | - Gang Sun
- Department of Radiological Diagnosis, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China
| | - Fengyu Jia
- Department of Nephrology, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China.
| | - Kai Liu
- Department of Radiological Diagnosis, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China.
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Wang H, Liu X, Song L, Yang W, Li M, Chen Q, Lv H, Zhao P, Yang Z, Liu W, Wang ZC. Dysfunctional Coupling of Cerebral Blood Flow and Susceptibility Value in the Bilateral Hippocampus is Associated with Cognitive Decline in Nondialysis Patients with CKD. J Am Soc Nephrol 2023; 34:1574-1588. [PMID: 37476849 PMCID: PMC10482064 DOI: 10.1681/asn.0000000000000185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
SIGNIFICANCE STATEMENT Patients with end stage CKD often develop cognitive decline, but whether this is related to the underlying disease or to hemodialysis remains unclear. We performed three-dimensional pseudocontinuous arterial spin labeling and quantitative susceptibility mapping prospectively in 40 patients with stage 1-4 CKD, 47 nondialysis patients with stage 5 CKD, and 44 healthy controls. Our magnetic resonance imaging data demonstrate that changes in cerebral blood flow-susceptibility coupling might underlie this cognitive decline, perhaps in the hippocampus and thalamus. These results suggest that magnetic resonance imaging parameters are potential biomarkers of cognitive decline in patients with CKD. Moreover, our findings may lead to discovery of novel therapeutic targets to prevent cognitive decline in patients with CKD. BACKGROUND Cerebral blood flow (CBF) and susceptibility values reflect vascular and iron metabolism, providing mechanistic insights into conditions of health and disease. Nondialysis patients with CKD show a cognitive decline, but the pathophysiological mechanisms underlying this remain unclear. METHODS Three-dimensional pseudocontinuous arterial spin labeling and quantitative susceptibility mapping were prospectively performed in 40 patients with stage 1-4 CKD (CKD 1-4), 47 nondialysis patients with stage 5 CKD (CKD 5ND), and 44 healthy controls (HCs). Voxel-based global and regional analyses of CBF, susceptibility values, and vascular-susceptibility coupling were performed. Furthermore, the association between clinical performance and cerebral perfusion and iron deposition was analyzed. RESULTS For CBF, patients with CKD 5ND had higher normalized CBF in the hippocampus and thalamus than HCs. Patients with CKD 5ND had higher normalized CBF in the hippocampus and thalamus than those with CKD 1-4. The susceptibility values in the hippocampus and thalamus were lower in patients with CKD 5ND than in HCs. Patients with CKD 5ND had higher susceptibility value in the caudate nucleus than those with CKD 1-4. More importantly, patients with CKD 5ND had lower CBF-susceptibility coupling than HCs. In addition, CBF and susceptibility values were significantly associated with clinical performance. CONCLUSIONS Our findings demonstrate a new neuropathological mechanism in patients with CKD, which leads to regional changes in CBF-susceptibility coupling. These changes are related to cognitive decline, providing potential imaging markers for assessing clinical disability and cognitive decline in these patients.
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Affiliation(s)
- Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijun Song
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenbo Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mingan Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhen-chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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11
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Song W, Zhao L, Li X, Wu B. Altered brain activity in patients with end-stage renal disease: A meta-analysis of resting-state functional imaging. Brain Behav 2023:e3057. [PMID: 37190900 DOI: 10.1002/brb3.3057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Previous studies have revealed abnormal resting-state brain activity in patients with end-stage renal disease (ESRD); however, the results are inconsistent. Thus, we conducted a coordinate-based meta-analysis of whole-brain resting-state functional neuroimaging studies in ESRD to identify the most consistent neural activity alterations in ESRD patients and explore their relation to serological indicators. METHODS A comprehensive literature search strategy was applied to select pertinent studies up to December 2022 in PubMed, Web of Science, and Embase databases. Voxel-wise meta-analysis was conducted via the latest meta-analytic algorithm, seed-based d mapping with permutation of subject images software. Meta-regression analyses were also conducted to explore the potential effect of clinical variables on resting-state neural activity. RESULTS Eleven studies comprising 304 patients with ESRD and 296 healthy controls (HCs) were included. Compared with HCs, ESRD patients showed decreased brain activity in the default mode network (DMN) regions, including the bilateral anterior cingulate cortex/medial prefrontal cortex, bilateral midcingulate cortex/posterior cingulate cortex, bilateral precuneus, and right angular gyrus. The neural activities in the bilateral midcingulate cortex, bilateral midcingulate cortex/posterior cingulate cortex, and right angular gyrus were significantly associated with serological indexes including hemoglobin, urea, and creatinine levels. CONCLUSION The present study provides a quantitative overview of brain activity alterations in patients with ESRD, and the results confirm the essential role of the DMN in ESRD patients, which may be the potential neural basis of their cognitive deficits. Additionally, some serological indicators may be used as predictive markers for progressive impairment of brain function.
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Affiliation(s)
- Wenjuan Song
- Department of Radiology, First People's Hospital of Linping District, Hangzhou, China
| | - Liuyan Zhao
- Department of Radiology, First People's Hospital of Linping District, Hangzhou, China
| | - Xuekun Li
- Department of Magnetic Resonance, First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Baolin Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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12
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Park KM, Heo CM, Lee DA, Lee YJ, Park S, Kim YW, Park BS. The effects of hemodialysis on the functional brain connectivity in patients with end-stage renal disease with functional near-infrared spectroscopy. Sci Rep 2023; 13:5691. [PMID: 37029163 PMCID: PMC10082020 DOI: 10.1038/s41598-023-32696-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
This study aimed to investigate functional brain connectivity in patients with end-stage renal disease (ESRD) undergoing hemodialysis using functional near-infrared spectroscopy (fNIRS) and to analyze the effect of hemodialysis on functional brain connectivity. We prospectively enrolled patients with ESRD undergoing hemodialysis for > 6 months without any history of neurological or psychiatric disorders. fNIRS data were acquired using a NIRSIT Lite device. Measurements were performed thrice in the resting state for each patient: before the start of hemodialysis (pre-HD), 1 h after the start of hemodialysis (mid-HD), and after the end of hemodialysis (post-HD). We processed and exported all data, and created a weighted connectivity matrix using Pearson correlation analysis. We obtained functional connectivity measures from the connectivity matrix by applying a graph theoretical analysis. We then compared differences in functional connectivity measures according to hemodialysis status in patients with ESRD. We included 34 patients with ESRD. There were significant changes in the mean clustering coefficient, transitivity, and assortative coefficient between the pre- and post-HD periods (0.353 vs. 0.399, p = 0.047; 0.523 vs. 0.600, p = 0.042; and 0.043 vs. - 0.012, p = 0.044, respectively). However, there were no changes in the mean clustering coefficient, transitivity, and assortative coefficient between the pre- and mid-HD periods, or between the mid- and post-HD periods. In addition, there were no significant differences in the average strength, global efficiency, and local efficiency among the pre-, mid-, and post-HD periods. We demonstrated a significant effect of hemodialysis on functional brain connectivity in patients with ESRD. Functional brain connectivity changes more efficiently during hemodialysis.
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Affiliation(s)
- Kang Min Park
- Department of Neurology, Inje University College of Medicine, Busan, Korea
| | - Chang Min Heo
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Dong Ah Lee
- Department of Neurology, Inje University College of Medicine, Busan, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea.
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13
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Zhang D, Chen Y, Shen J, Xie Q, Jing L, Lin L, Wang Q, Wu J. Static and Dynamic Characteristics of Functional Network Connectivity in Neurologically Asymptomatic Patients Undergoing Maintenance Hemodialysis: A Resting-State Functional MRI Study. J Magn Reson Imaging 2023; 57:420-431. [PMID: 35762494 PMCID: PMC10084323 DOI: 10.1002/jmri.28317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The characteristics of static functional network connectivity (sFNC) and dynamic FNC (dFNC) in neurologically asymptomatic patients undergoing maintenance hemodialysis are unknown. Elucidating these characteristics may improve our understanding of the mechanisms of neuropathological damage in these patients. PURPOSE To explore the static and dynamic characteristics of FNC in neurologically asymptomatic patients undergoing maintenance hemodialysis and the relationship between FNC-related parameters with the neuropsychological scores and blood biomarkers. STUDY TYPE Retrospective. POPULATION A total of 23 neurologically asymptomatic patients undergoing maintenance hemodialysis and 25 healthy controls matched for age, sex, and years of education. FIELD STRENGTH/SEQUENCE A 3.0 T MRI/functional MRI and three-dimensional-T1 structural imaging ASSESSMENT: Independent components; spatial map intensity; sFNC and dFNC strengths; and time attribute parameters (mean dwell time, fractional window, and number of transitions) were determined. Neuropsychological tests were performed. Blood biochemical tests were performed for the patients but not healthy controls. STATISTICAL TESTS Chi-squared test, one-sample t-test, two-sample t-test, partial correlation analysis, and family-wise error and false discovery rate correction. P < 0.05 denoted statistical significance. RESULTS Significant group differences in the strengths of sFNC and dFNC between networks were found. The sFNC strength between the visual and sensorimotor networks was significantly associated with the global cognitive function score (i.e. the Montreal Cognitive Assessment [MoCA]) (r = 0.606). The sFNC strength between the salience and default mode networks was significantly associated with anxiety scores (r = 0.458). In state 1, positive correlations were found between the mean dwell time and backward digital span task score (r = 0.562), fractional window and MoCA score (r = 0.576), and fractional window and backward digital span task score (r = 0.592). DATA CONCLUSION Neurologically asymptomatic patients undergoing maintenance hemodialysis had defective sFNC and dFNC. Our results provide a new perspective on the mechanism of neuropathological damage in patients undergoing maintenance hemodialysis. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Die Zhang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China.,Department of Radiology, Shenzhen Third People's Hospital, Longgang District, Shenzhen, Guangdong, People's Republic of China
| | - Yingying Chen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China.,Department of Radiology, National Cancer Centre, National Clinical Research Centre for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, People's Republic of China
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Qing Xie
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Li Jing
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Lin Lin
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Qiong Wang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
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14
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Cao H, Lin F, Ke B, Song J, Xue Y, Fang X, Zeng E. Alterations of amplitude of low-frequency fluctuations and fractional amplitude of low-frequency fluctuations in end-stage renal disease on maintenance dialysis: An activation likelihood estimation meta-analysis. Front Hum Neurosci 2022; 16:1040553. [PMID: 36530199 PMCID: PMC9751321 DOI: 10.3389/fnhum.2022.1040553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/16/2022] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Cognitive impairment (CI) is a common complication of end-stage renal disease (ESRD). Many resting-state functional magnetic resonance imaging (rs-fMRI) studies have identified abnormal spontaneous low-frequency brain activity in ESRD dialysis patients. However, these studies have reported inconsistent results. So far, no meta-analyses on this topic have been published. This meta-analysis aimed to identify the more consistently vulnerable brain regions in ESRD patients at rest and to reveal its possible neuropathophysiological mechanisms. METHODS We systematically searched PubMed, Cochrane Library, Web of Science, Medline, and EMBASE databases up to July 20, 2022 based on the amplitude of low-frequency fluctuation (ALFF) or fractional amplitude of low-frequency fluctuation (fALFF). Brain regions with abnormal spontaneous neural activity in ESRD compared to healthy controls (HCs) from previous studies were integrated and analyzed using an activation likelihood estimation (ALE) method. Jackknife sensitivity analysis was carried out to assess the reproducibility of the results. RESULTS In total, 11 studies (380 patients and 351 HCs) were included in the final analysis. According to the results of the meta-analysis, compared with HCs, ESRD patients had decreased ALFF/fALFF in the right precuneus, right cuneus, and left superior temporal gyrus (STG), while no brain regions with increased brain activity were identified. Jackknife sensitivity analysis showed that our results were highly reliable. CONCLUSION Compared to HCs, ESRD dialysis patients exhibit significant abnormalities in spontaneous neural activity associated with CI, occurring primarily in the default mode network, visual recognition network (VRN), and executive control network (ECN). This contributes to the understanding of its pathophysiological mechanisms. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022348694].
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Affiliation(s)
- Huiling Cao
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Feng Lin
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ben Ke
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianling Song
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuting Xue
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiangdong Fang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Erming Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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15
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Yuan H, Li H, Mu J, Gu W, Zhu X, Gao L, Zhang Y, Ma S. Reduced cortical complexity in patients with end-stage kidney disease prior to dialysis initiation. Front Neurosci 2022; 16:971010. [PMID: 36389216 PMCID: PMC9659747 DOI: 10.3389/fnins.2022.971010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
Abstract
End-stage kidney disease (ESKD) is associated with cognitive impairment (CI) and affects different aspects of cortical morphometry, but where these changes converge remains unclear. Fractal dimension (FD) is used to represent cortical complexity (CC), which describes the structural complexity of the cerebral cortex by integrating different cortical morphological measures. This study aimed to investigate changes in CC in patients with ESKD prior to initiation of dialysis and to evaluate the relationship between changes in CC, cognitive performance, and uremic toxins. Forty-nine patients with ESKD naive to dialysis and 31 healthy controls (HCs) were assessed using structural magnetic resonance imaging (MRI) and cognitive tests, including evaluations of global cognitive function, memory, and executive function. Clinical laboratory blood tests were performed on all patients with ESKD, including measurement of nine uremic toxin-related indices. CC was measured using MRI data to determine regional FD values. We estimated the association between cognitive performance, uremic toxin levels, and CC changes. Compared to HCs, patients with ESKD showed significantly lower CC in the left precuneus (p = 0.006), left middle temporal cortex (p = 0.010), and left isthmus cingulate cortex (p = 0.018). Furthermore, lower CC in the left precuneus was associated with impaired long-term delayed memory (Pearson r = 0.394, p = 0.042) in patients with ESKD. Our study suggests that regional decreases in CC are an additional characteristic of patients with ESKD naive to dialysis, related to impaired long-term memory performance. These findings may help further understand the underlying neurobiological mechanisms between brain structural changes and CI in patients with ESKD.
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Affiliation(s)
- Huijie Yuan
- Department of Medical Imaging, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haining Li
- Department of Medical Imaging, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Junya Mu
- Department of Medical Imaging, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wen Gu
- Department of Medical Imaging, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xinyi Zhu
- Department of Medical Imaging, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuchen Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Yuchen Zhang,
| | - Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Shaohui Ma,
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16
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Li P, Ma S, Ma X, Ding D, Zhu X, Zhang H, Liu J, Mu J, Zhang M. Reversal of neurovascular decoupling and cognitive impairment in patients with end-stage renal disease during a hemodialysis session: Evidence from a comprehensive fMRI analysis. Hum Brain Mapp 2022; 44:989-1001. [PMID: 36269166 PMCID: PMC9875915 DOI: 10.1002/hbm.26122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
Neurovascular (NV) decoupling is a potential neuropathologic mechanism of cognitive impairment in patients with end-stage renal disease (ESRD). Hemodialysis improves cognitive impairment at 24 h post-dialysis, which suggests a potential neuroprotective effect of hemodialysis treatment on the brain. We investigated the effects of hemodialysis treatment on the reversal of NV decoupling associated with cognitive improvement. A total of 39 patients with ESRD and 39 healthy controls were enrolled. All patients were imaged twice during a dialysis session: before hemodialysis (T1pre-dialysis ) and at 24 h after dialysis (T2post-dialysis ). The healthy controls were imaged once. NV coupling was characterized based on correlation coefficients between four types of blood oxygen level-dependent signals and cerebral blood flow (CBF). A battery of neuropsychological and blood tests was performed before the imaging. Patients with ESRD showed improvements in memory and executive function at T2post-dialysis compared with that at T1pre-dialysis . At both T1pre-dialysis and T2post-dialysis , patients with ESRD had lower amplitude of low-frequency fluctuation (ALFF)-CBF coupling than healthy controls. Additionally, patients with ESRD had higher ALFF-CBF coupling at T2post-dialysis than at T1pre-dialysis . Higher memory scores, higher hemoglobin level, lower total plasma homocysteine level, lower systolic blood pressure variance, and lower ultrafiltration volume were associated with higher ALFF-CBF coupling in patients with ESRD after a hemodialysis session. These findings indicate that partial correction of anemia and hyperhomocysteinemia, stable systolic blood pressure, and fluid restriction may be closely linked to the reversal of NV decoupling and improvement in cognition in patients with ESRD.
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Affiliation(s)
- Peng Li
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina,Department of Medical ImagingNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangShaanxiChina
| | - Shaohui Ma
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Xueying Ma
- Department of Medical ImagingThe Affiliated Hospital of Inner Mongolia Medical UniversityHohhotInner MongoliaChina
| | - Dun Ding
- Department of Medical ImagingSecond Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Xinyi Zhu
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Huawen Zhang
- Department of Medical ImagingNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangShaanxiChina
| | - Jixin Liu
- Center for Brain ImagingSchool of Life Science and Technology, Xidian UniversityXi'anChina
| | - Junya Mu
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Ming Zhang
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
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17
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Peng C, Ran Q, Liu CX, Zhang L, Yang H. The instant impact of a single hemodialysis session on brain morphological measurements in patients with end-stage renal disease. Front Hum Neurosci 2022; 16:967214. [PMID: 36082229 PMCID: PMC9445124 DOI: 10.3389/fnhum.2022.967214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the instant impact of hemodialysis (HD) on the cerebral morphological measurements of patients with end-stage renal disease (ESRD).Materials and methodsTwenty-five patients undergoing maintenance HD and twenty-eight age-, sex-, and education-matched healthy control (HC) were included. The HD group and HC group had 3D high-resolution structural magnetic resonance imaging (MRI) scans twice and once, respectively. Both groups underwent neuropsychologic tests. The morphological measurements of structural MRI were measured using CAT12 and these measures were compared among three groups. The relationship between morphological measures and clinical parameters and neuropsychological tests were investigated through multiple regression analysis.ResultsCompared to the HC group, the cortical thickness before HD significantly decreased in the bilateral temporal lobe and significantly decreased in the left superior temporal gyrus after HD. The cortical thickness significantly increased in the bilateral temporal lobe, frontal lobe and occipital lobe after HD compared to before HD. The sulcus depth in the bilateral insula, frontal lobe, and parietal lobe after HD significantly increased compared to before HD. No significant differences in sulcus depth between HD and HC were detected. After HD, the cortical thickness of the right parsopercularis was positively correlated with the number connection test-A. Cortical thickness in multiple regions were positively correlated with blood flow velocity and cortical thickness in the left parahippocampal gyrus was negatively correlated with ultrafiltration volume. Patients showed better performance in the digit symbol test and line tracing test after HD compared to before HD, but there were no significant differences in the comparison of neuropsychologic tests between patients and HC.ConclusionThe instant morphological changes were captured during a single hemodialysis in HD patients. There was an association between these instant changes in the brain and clinical parameters and neuropsychologic tests. This work implied the instant impact of a single hemodialysis impact on the brain in HD patients.
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Affiliation(s)
- Cong Peng
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qian Ran
- Department of Radiology, Xinqiao Hospital, Chongqing, China
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium
| | - Cheng Xuan Liu
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ling Zhang
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Hua Yang
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Hua Yang,
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18
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Cao C, Zhang D, Liu W. Abnormal topological parameters in the default mode network in patients with impaired cognition undergoing maintenance hemodialysis. Front Neurol 2022; 13:951302. [PMID: 36062001 PMCID: PMC9433780 DOI: 10.3389/fneur.2022.951302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The role of the default mode network (DMN) in the cognitive impairment experienced by patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD) remains unknown. This study tested the hypothesis that the topological architecture of the DMN plays a key role in ESRD-related cognitive impairment. Methods For this study, 43 ERSD patients receiving MHD and 41 healthy control (HC) volunteers matched for gender, age and education underwent resting-state functional magnetic resonance imaging examinations. DMN architecture was depicted by 20 selected DMN subregions. Graph theory approaches were applied to investigate multiple topological parameters within the DMN in resting state at the global, local and edge levels. Results Globally, the MHD group exhibited topological irregularities as indicated by reduced values for the clustering coeffcient (Cp), normalized Cp (γ), world-index (σ), and local effciency (Eloc) compared with the HC group. Locally, the MHD group showed greater nodal betweenness in the left retrosplenial cortex (RC) compared with the HC group. At the edge level, the MHD group exhibited disconnected resting-state functional connections (RSFCs) in the medial temporal lobe (MTL) subsystem including the ventral medial prefrontal cortex (VMPC)–left posterior inferior parietal lobule, VMPC–right parahippocampal cortex (PC), and right RC–left PC RSFCs. Additionally, the VMPC–right PC RSFC was positively correlated with the Digit Span Test score and Eloc, and the right RC–left PC RSFC was positively correlated with the Montreal Cognitive Assessment score and Eloc in the MHD group. Conclusions ESRD patients undergoing MHD showed local inefficiency, abnormal nodal centralities, and hypoconnectivity within the DMN, implying that the functional differentiation and local information transmission efficiency of the DMN are disturbed in ESRD. The disconnected RSFCs in the MTL subsystem likely facilitated topological reconfiguration in the DMN of ESRD patients, leading to impairments of multidomain neurocognition including memory and emotion regulation.
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Affiliation(s)
- Chuanlong Cao
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Affiliated Xinhua Hospital of Dalian University, Dalian, China
| | - Die Zhang
- Department of Radiology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, School of Medicine Southern University of Science and Technology, Shenzhen, China
| | - Wanqing Liu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- *Correspondence: Wanqing Liu
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19
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Wu X, Jiang Z, Zheng J, Jiao Z, Liu T, Dou W, Shi H. Intravoxel incoherent motion to assess brain microstructure and perfusion in patients with end-stage renal disease. J Neuroimaging 2022; 32:930-940. [PMID: 35817591 DOI: 10.1111/jon.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the clinical value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging in evaluating the brain microstructure and perfusion changes in end-stage renal disease (ESRD) patients. METHODS The routine head MRI sequences and IVIM were performed on 40 ESRD patients and 30 healthy subjects. The IVIM was executed with 10 b-values varying from 0 to 1000 seconds/mm2 . All subjects were evaluated on neuropsychological test. Laboratory tests were conducted for ESRD patients. RESULTS Compared with the control group, increased slow apparent diffusion coefficient values (ADCslow ) were found in the left frontal lobe, hippocampus, bilateral temporal lobe, and the right occipital lobe (p < .05), and increased fast ADC values (ADCfast ) were found in all regions of interest (all p < .001) in ESRD patients. In ESRD patients, ADCfast in right frontal lobe (p = .041) and insular lobe (p = .045) was negatively correlated with the Montreal Cognitive Assessment score (MoCA), and ADCfast in the right parietal lobe (p = .009) and hippocampus (p = .041) had positive correlation with hemoglobin levels. Using receiver operating characteristics (ROC) analysis, ADCfast in the right frontal lobe, insular lobe, hippocampus, and parietal lobe separately showed fair to good efficacy in differentiating ESRD patients from healthy subjects, with the area under the ROC ranging from .853 to .903. CONCLUSIONS The microstructure and perfusion of the brain were impaired in ESRD patients. ADCfast of the right frontal lobe, insular lobe, hippocampus, and parietal lobe could be effective biomarker for evaluating cognitive impairment in ESRD patients.
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Affiliation(s)
- Xiangxiang Wu
- Graduate College, Dalian Medical University, Dalian, China.,Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Zijian Jiang
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Jiahui Zheng
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China.,Graduate College, Nanjing Medical University, Nanjing, China
| | - Zhuqing Jiao
- School of Microelectronics and Control Engineering, Changzhou University, Changzhou, China
| | - Tongqiang Liu
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Weiqiang Dou
- Department of MR Research, GE Healthcare China, Beijing, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
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20
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Fischer D, Newcombe V, Fernandez-Espejo D, Snider SB. Applications of Advanced MRI to Disorders of Consciousness. Semin Neurol 2022; 42:325-334. [PMID: 35790201 DOI: 10.1055/a-1892-1894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disorder of consciousness (DoC) after severe brain injury presents numerous challenges to clinicians, as the diagnosis, prognosis, and management are often uncertain. Magnetic resonance imaging (MRI) has long been used to evaluate brain structure in patients with DoC. More recently, advances in MRI technology have permitted more detailed investigations of the brain's structural integrity (via diffusion MRI) and function (via functional MRI). A growing literature has begun to show that these advanced forms of MRI may improve our understanding of DoC pathophysiology, facilitate the identification of patient consciousness, and improve the accuracy of clinical prognostication. Here we review the emerging evidence for the application of advanced MRI for patients with DoC.
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Affiliation(s)
- David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Virginia Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Davinia Fernandez-Espejo
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Samuel B Snider
- Division of Neurocritical Care, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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21
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Li X, Yan R, Yue Z, Zhang M, Ren J, Wu B. Abnormal Dynamic Functional Connectivity in Patients With End-Stage Renal Disease. Front Neurosci 2022; 16:852822. [PMID: 35669490 PMCID: PMC9163405 DOI: 10.3389/fnins.2022.852822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Dynamic functional connectivity (FC) analysis can capture time-varying properties of connectivity; however, studies focusing on dynamic FC in patients with end-stage renal disease (ESRD) are very limited. This is the first study to explore the dynamic aspects of whole-brain FC and topological properties in ESRD patients. Resting-state functional magnetic resonance imaging data were acquired from 100 ESRD patients [50 hemodialysis (HD) patients and 50 non-dialysis patients] and 64 healthy controls (HCs). Independent component analysis, a sliding-window approach and graph-theory methods were used to study the dynamic FC properties. The intrinsic brain FC were clustered into four configuration states. Compared with HCs, both patient groups spent longer time in State 3, in which decreased FC between subnetworks of the default mode network (DMN) and between the dorsal DMN and language network was observed in these patients, and a further reduction in FC between the DMN subnetworks was found in HD patients compared to non-dialysis patients. The number of transitions and the variability of global and local efficiency progressively decreased from that in HCs to that of non-dialysis patients to that of HD patients. The completion time of Trail Making Test A and Trail Making Test B positively correlated with the mean dwell time of State 3 and negatively correlated with the number of transitions in ESRD patients. Our findings suggest impaired functional flexibility of network connections and state-specific FC disruptions in patients with ESRD, which may underlie their cognitive deficits. HD may have an adverse effect on time-varying FC.
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22
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Herrington JD, Hartung EA, Laney NC, Hooper SR, Furth SL. Decreased Neural Connectivity in the Default Mode Network Among Youth and Young Adults With Chronic Kidney Disease. Semin Nephrol 2021; 41:455-461. [PMID: 34916007 DOI: 10.1016/j.semnephrol.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An increasing amount of literature has indicated that chronic kidney disease (CKD) is associated with cognitive deficits that increase with worsening disease severity. Although abnormalities in brain structure have been widely documented, few studies to date have examined the functioning of brain areas associated with the specific cognitive domains affected by CKD (namely, attention and executive functions). Furthermore, few studies have examined functional connectivity among CKD youth who are relatively early in the course of the disease. The present study used functional magnetic resonance imaging to examine the resting state connectivity in 67 youth with CKD (mean age, 17 y) and 58 age-matched healthy controls. Using seed-based multiple regression, decreased connectivity was observed within the anterior cingulate portion of the default mode network. In addition, decreased connectivity within the dorsolateral prefrontal cortex, paracingulate gyrus, and frontal pole were correlated significantly with disease severity. These data indicate that connectivity deficits in circuits implementing attentional processes may represent an early marker for cognitive decline in CKD.
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Affiliation(s)
- John D Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Child Psychiatry and Behavioral Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nina C Laney
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina School-Chapel Hill, Chapel Hill, NC
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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23
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Chang TY, Wu HH, Li YJ, Liu HL, Yeh CH, Jian HS, Huang KL, Lee TH, Tian YC, Wu CW. Changes of Brain Functional Connectivity in End-Stage Renal Disease Patients Receiving Peritoneal Dialysis Without Cognitive Decline. Front Med (Lausanne) 2021; 8:734410. [PMID: 34901056 PMCID: PMC8652044 DOI: 10.3389/fmed.2021.734410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Functional connectivity detected by resting-state functional MRI (R-fMRI) helps to discover the subtle changes in brain activities. Patients with end-stage renal disease (ESRD) on hemodialysis (HD) have impaired brain networks. However, the functional changes of brain networks in patients with ESRD undergoing peritoneal dialysis (PD) have not been fully delineated, especially among those with preserved cognitive function. Therefore, it is worth knowing about the brain functional connectivity in patients with PD by using R-fMRI. Methods: This case-control study prospectively enrolled 19 patients with ESRD receiving PD and 24 age- and sex- matched controls. All participants without a history of cognitive decline received mini-mental status examination (MMSE) and brain 3-T R-fMRI. Comprehensive R-fMRI analyses included graph analysis for connectivity and seed-based correlation networks. Independent t-tests were used for comparing the graph parameters and connectivity networks between patients with PD and controls. Results: All subjects were cognitively intact (MMSE > 24). Whole-brain connectivity by graph analysis revealed significant differences between the two groups with decreased global efficiency (Eglob, p < 0.05), increased betweenness centrality (BC) (p < 0.01), and increased characteristic path length (L, p < 0.01) in patients with PD. The functional connections of the default-mode network (DMN), sensorimotor network (SMN), salience network (SN), and hippocampal network (HN) were impaired in patients with PD. Meanwhile, in DMN and SN, elevated connectivity was observed in certain brain regions of patients with PD. Conclusion: Patients with ESRD receiving PD had specific disruptions in functional connectivity. In graph analysis, Eglob, BC, and L showed significant connectivity changes compared to the controls. DMN and SN had the most prominent alterations among the observed networks, with both decreased and increased connectivity regions. Our study confirmed that significant changes in cerebral connections existed in cognitively intact patients with PD.
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Affiliation(s)
- Ting-Yu Chang
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Hsu Wu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jung Li
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hui-Shan Jian
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kuo-Lun Huang
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Shuang-Ho Hospital-Taipei Medical University, New Taipei, Taiwan
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24
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Li P, Mu J, Ma X, Ding D, Ma S, Zhang H, Liu J, Zhang M. Neurovascular coupling dysfunction in end-stage renal disease patients related to cognitive impairment. J Cereb Blood Flow Metab 2021; 41:2593-2606. [PMID: 33853410 PMCID: PMC8504946 DOI: 10.1177/0271678x211007960] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to investigate the neurovascular coupling (NVC) dysfunction in end-stage renal disease (ESRD) patients related with cognitive impairment. Twenty-five ESRD patients and 22 healthy controls were enrolled. To assess the NVC dysfunctional pattern, resting-state functional MRI and arterial spin labeling were explored to estimate the coupling of spontaneous neuronal activity and cerebral blood perfusion based on amplitude of low-frequency fluctuation (ALFF)-cerebral blood flow (CBF), fractional ALFF (fALFF)-CBF, regional homogeneity (ReHo)-CBF, and degree centrality (DC)-CBF correlation coefficients. Multivariate partial least-squares correlation and mediation analyses were used to evaluate the relationship among NVC dysfunctional pattern, cognitive impairment and clinical characteristics. The NVC dysfunctional patterns in ESRD patients were significantly decreased in 34 brain regions compared with healthy controls. The decreased fALFF-CBF coefficients in the cingulate gyrus (CG) were associated positively with lower kinetic transfer/volume urea (Kt/V) and lower short-term memory scores, and were negatively associated with higher serum urea. The relationship between Kt/V and memory deficits of ESRD patients was partially mediated by the fALFF-CBF alteration of the CG. These findings reveal the NVC dysfunction may be a potential neural mechanism for cognitive impairment in ESRD. The regional NVC dysfunction may mediate the impact of dialysis adequacy on memory function.
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Affiliation(s)
- Peng Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, China.,Department of Medical Imaging, Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xueying Ma
- Department of Medical Imaging, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Dun Ding
- Department of Medical Imaging, The Second Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, China
| | - Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, China
| | - Huawen Zhang
- Department of Medical Imaging, Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, China
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25
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Abnormal degree centrality in end-stage renal disease (ESRD) patients with cognitive impairment: a resting-state functional MRI study. Brain Imaging Behav 2021; 15:1170-1180. [PMID: 32902798 DOI: 10.1007/s11682-020-00317-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To investigate functional connectivity (FC) changes in end-stage renal disease (ESRD) patients with and without cognitive impairment (CI) by using resting-state functional magnetic resonance imaging (rs-fMRI). Twenty-three ESRD patients with CI, 22 ESRD patients with non-CI (NCI) and 23 matched healthy controls (HC) were included. Rs-fMRI scans were performed in all subjects. Full-range, long-range, and short-range FC defined voxel-wise based degree centrality (DC) and seed based FC were computed and contrasted among the groups. Compared with HC, the DC value of short functional connectivity (SFC), in ESRD patients have increased on the left supramarginal gyrus, while it reduced on the left insula and right postcentral gyrus in CI and decreased on the right precentral gyrus in NCI. Compared with NCI, the DC value of LFC in CI increased on the left fusiform gyrus, while the DC value of short functional connectivity (SFC) increased on the left middle orbital gyrus. In the seed-based FC analyses, the CI showed significantly decreased FC between the left insula and bilateral middle temporal gyrus, between the left fusiform gyrus and the right hippocampus, and between the left postcentral gyrus and the right parahippocampus compared to HC; the CI showed significantly increased FC between the left precuneus and the left fusiform gyrus, between the left postcentral gyrus and the right precuneus compared with NCI. Positive correlations were found between DC values on the right superior frontal gyrus and LDL and BDST, and between MoCA and the DC values on the left insula and the left postcentral gyrus. The altered degree centrality may serve as early biomarkers for CI in ESRD patients.
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26
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Chai C, Wang H, Chu Z, Li J, Qian T, Mark Haacke E, Xia S, Shen W. Reduced regional cerebral venous oxygen saturation is a risk factor for the cognitive impairment in hemodialysis patients: a quantitative susceptibility mapping study. Brain Imaging Behav 2021; 14:1339-1349. [PMID: 30511117 DOI: 10.1007/s11682-018-9999-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to noninvasively evaluate the changes of regional cerebral venous oxygen saturation (rSvO2) in hemodialysis patients using quantitative susceptibility mapping (QSM) and investigate the relationship with clinical risk factors and neuropsychological testing. Fifty four (54) hemodialysis patients and 54 age, gender and education matched healthy controls (HCs) were recruited in this prospective study. QSM data were reconstructed from the original phase data of susceptibility weighted imaging to measure the susceptibility of cerebral regional major veins in all subjects and calculate their rSvO2. The differences in rSvO2 between hemodialysis patients and HCs were investigated using analysis of covariance adjusting for age and gender as covariates. Stepwise multiple regression and correlation analysis were performed between the cerebral rSvO2 and clinical factors including neuropsychological testing. The SvO2 of the bilateral cortical, thalamostriate, septal, cerebral internal and basal veins in hemodialysis patients was significantly lower than that in HCs (p < 0.001, Bonferroni corrected). The cerebral rSvO2 in all these veins was reduced by 1.67% to 2.30%. The hematocrit, iron, glucose, pre-and post-dialysis diastolic blood pressure (DBP) were independent predictive factors for the cerebral rSvO2 (all P < 0.05). The Mini-Mental State Examination and Montreal Cognitive Assessment (MoCA) scores were both lower in patients than those in HCs (both P < 0.05). The SvO2 of the left cerebral internal vein correlated with MoCA scores (r = 0.492; P = 0.02, FDR corrected). In conclusion, our study indicated that the cerebral rSvO2 was reduced in hemodialysis patients, which was the risk factor for neurocognitive impairment. The hematocrit, iron, glucose, pre-and post-dialysis DBP were independent risk factors for the cerebral rSvO2.
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Affiliation(s)
- Chao Chai
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Huiying Wang
- School of Graduates, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Zhiqiang Chu
- Department of Hemodialysis, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Jinping Li
- Department of Hemodialysis, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Tianyi Qian
- MR collaboration, Siemens Healthcare, Northeast Asia, Beijing, 100102, China
| | - E Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, 48202, USA
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China.
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China.
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27
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Rossetti GM, d'Avossa G, Rogan M, Macdonald JH, Oliver SJ, Mullins PG. Reversal of neurovascular coupling in the default mode network: Evidence from hypoxia. J Cereb Blood Flow Metab 2021; 41:805-818. [PMID: 32538282 PMCID: PMC7983511 DOI: 10.1177/0271678x20930827] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Local changes in cerebral blood flow are thought to match changes in neuronal activity, a phenomenon termed neurovascular coupling. Hypoxia increases global resting cerebral blood flow, but regional cerebral blood flow (rCBF) changes are non-uniform. Hypoxia decreases baseline rCBF to the default mode network (DMN), which could reflect either decreased neuronal activity or altered neurovascular coupling. To distinguish between these hypotheses, we characterized the effects of hypoxia on baseline rCBF, task performance, and the hemodynamic (BOLD) response to task activity. During hypoxia, baseline CBF increased across most of the brain, but decreased in DMN regions. Performance on memory recall and motion detection tasks was not diminished, suggesting task-relevant neuronal activity was unaffected. Hypoxia reversed both positive and negative task-evoked BOLD responses in the DMN, suggesting hypoxia reverses neurovascular coupling in the DMN of healthy adults. The reversal of the BOLD response was specific to the DMN. Hypoxia produced modest increases in activations in the visual attention network (VAN) during the motion detection task, and had no effect on activations in the visual cortex during visual stimulation. This regional specificity may be particularly pertinent to clinical populations characterized by hypoxemia and may enhance understanding of regional specificity in neurodegenerative disease pathology.
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Affiliation(s)
- Gabriella Mk Rossetti
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Giovanni d'Avossa
- Bangor Imaging Centre, School of Psychology, College of Human Sciences, Bangor University, Bangor, UK
| | - Matthew Rogan
- Bangor Imaging Centre, School of Psychology, College of Human Sciences, Bangor University, Bangor, UK
| | - Jamie H Macdonald
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Samuel J Oliver
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Paul G Mullins
- Bangor Imaging Centre, School of Psychology, College of Human Sciences, Bangor University, Bangor, UK
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28
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Yue Z, Wang P, Li X, Ren J, Wu B. Abnormal brain functional networks in end-stage renal disease patients with cognitive impairment. Brain Behav 2021; 11:e02076. [PMID: 33605530 PMCID: PMC8035483 DOI: 10.1002/brb3.2076] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cognitive impairment (CI) is common in patients with end-stage renal disease (ESRD). Neuroimaging studies have demonstrated structural and functional brain alterations underlying CI in patients with ESRD. However, the patterns of change in whole-brain functional networks in ESRD patients with CI remain poorly understood. METHODS We enrolled 66 patients with ESRD (36 patients with CI and 30 patients without CI) and 48 healthy control subjects (HCs). We calculated the topological properties using a graph theoretical analysis. An analysis of covariance (ANCOVA) was used to compare network metrics among the three groups. Moreover, we analyzed the relationships between altered network measures and clinical variables in ESRD patients with CI. RESULTS Compared with HCs, both patient groups showed lower local efficiency and small-worldness. ESRD patients had decreased nodal centralities in the default mode regions and right amygdala. Comparison of the two patient groups showed significantly decreased global (small-worldness) and nodal (nodal centralities in the default mode regions) properties in the CI group. Altered nodal centralities in the bilateral medial part of the superior frontal gyrus, left posterior cingulate gyrus, and right precuneus were associated with cognitive performance in the CI group. CONCLUSION Disrupted brain functional networks were demonstrated in patients with ESRD, which were more severe in those with CI. Moreover, impaired nodal centralities in the default mode regions might underlie CI in patients with ESRD.
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Affiliation(s)
- Zheng Yue
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Pengming Wang
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Xuekun Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Jipeng Ren
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Baolin Wu
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China.,Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
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29
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Guo H, Liu W, Li H, Yang J. Structural and Functional Brain Changes in Hemodialysis Patients with End-Stage Renal Disease: DTI Analysis Results and ALFF Analysis Results. Int J Nephrol Renovasc Dis 2021; 14:77-86. [PMID: 33727853 PMCID: PMC7955761 DOI: 10.2147/ijnrd.s295025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/13/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction The current study aimed to depict intrinsic structural changes and the spontaneous brain activity patterns in voxel level in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) by using diffusion-tensor imaging and resting-state functional magnetic resonance (MR) imaging with an amplitude of low-frequency fluctuations (ALFF) algorithm and their clinical relevance. Materials and Methods In the study, the diffusion-tensor imaging and resting-state functional MR imaging were performed in forty-two hemodialysis patients with ESRD and 42 healthy control subjects. Neuropsychological and laboratory tests were performed in all subjects. ALFF, fraction anisotropy (FA), and mean diffusivity (MD) values were compared between the two groups. Correlations between ALFF, FA or MD values, and clinical markers were analyzed. Results We found that ESRD patients exhibited significantly lower ALFF values in multiple areas, including medial frontal gyrus, limbic lobe, superior frontal gyrus, bilateral lingual gyri, occipital lobe, parahippocampal gyrus, precuneus, while increased ALFF values in medial frontal gyrus than healthy controls. FA values were decreased in medial frontal gyrus, parietal lobe, and left precuneus regions in the ESRD group compared with controls. Importantly, FA for the frontal and parietal lobes was negatively associated with the dialysis duration of ESRD patients, ALFF z-scores for the medial prefrontal cortex (MPFC) were positively correlated with the dialysis duration of ESRD patients and Serum calcium of ESRD patients negatively correlated with FA values in the frontal and parietal lobes (p<0.05). Conclusion Our study revealed that both impaired brain structure and function in ESRD patients with routine hemodialysis distributed mainly in the parietal, temporal, and frontal lobes. ESRD patients have cognitive impairment and declined memory ability. Serum calcium and dialysis duration might be associated with the impairment of brain structure and function in patients with ESRD.
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Affiliation(s)
- Huiying Guo
- Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Wenjin Liu
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Haige Li
- Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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30
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Hu R, Gao L, Chen P, Wu B, Wu X, Xu H. How Do You Feel Now? The Salience Network Functional Connectivity in End-Stage Renal Disease. Front Neurosci 2020; 14:533910. [PMID: 33304233 PMCID: PMC7693456 DOI: 10.3389/fnins.2020.533910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The network connectivity basis of cognitive declines in end-stage renal disease (ESRD) remains unclear. A triple-network model of the salience (SN), executive control, and default mode networks has been suggested to be critical for efficient cognition. Here, we aimed to test the hypothesis that SN may play a role in cognitive impairment in patients with ESRD. Materials and Methods We investigated functional connectivity (FC) alterations within the SN between 43 ESRD patients (19 females/24 males, 46 ± 10 years) and 43 healthy controls (HC) (19 females/24 males, 47 ± 10 years), and performed linear support vector machine (LSVM) analysis on significant FC pairs within the SN to discriminate the two groups, and tested the accuracy of the classifier. Association and mediation analyses were conducted among the significant FC pairs within the SN nodes, clinical indicators, and neuropsychological tests scores. Results We identified significant between-group FC pairs within the SN and fairly good classification efficiency with significant accuracy (72.09%, p < 0.001). We found that FC between the right supramarginal gyrus and right anterior insula (AISL) was positively correlated with MoCA (r = 0.4010, p = 0.008); FC between the dorsal anterior cingulate cortex (dACC) and left AISL was positively correlated with the level of hemoglobin (r = 0.4979, p < 0.001). Mediation analysis found that the indirect effect of hemoglobin on forward digit span test scores via the FC between the dACC and right AISL (p < 0.05). Conclusion Disrupted SN connectivity may help explain cognitive declines in ESRD patients and act as a potential early biomarker. Moreover, the SN connectivity may interact with anemia to promote cognitive impairment.
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Affiliation(s)
- Runyue Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peina Chen
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Nephrology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Baolin Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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31
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Ma C, Tian F, Ma MG, Su HW, Fan JC, Li ZH, Ren YD. Preferentially Disrupted Core Hubs Within the Default-Mode Network in Patients With End-Stage Renal Disease: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurol 2020; 11:1032. [PMID: 33250836 PMCID: PMC7674924 DOI: 10.3389/fneur.2020.01032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/07/2020] [Indexed: 01/25/2023] Open
Abstract
Neuroimaging evidence implies that cognitive impairment in patients with end-stage renal disease (ESRD) is related to the disruption of the default-mode network (DMN). The DMN can be divided into three functionally independent subsystems, which include the cortical hub subsystem [consisting of the posterior cingulate cortex (PCC) and the anterior medial prefrontal cortex (aMPFC)], the dorsal medial prefrontal cortex (dMPFC) subsystem, and the medial temporal lobe (MTL) subsystem. However, it is unknown how the functional connectivity (FC) in DMN subsystems is differentially impaired in ESRD. This prospective study was carried out at the Affiliated Hospital of Qingdao University, China, between August 2018 and July 2020. Thirty-two ESRD patients and forty-five healthy controls (HCs) were recruited for this study and received resting-state functional magnetic resonance imaging (rs-fMRI) scanning, and FCs on predefined regions of interest (ROIs) were individually calculated in three DMN subsystems using both ROI- and seed-based FC analyses to examine FC alterations within and between DMN subsystems. The two-sample t-test was used for the comparisons between groups. We also tested the associations between FC changes and clinical information using Pearson's correlation analysis. The results demonstrated that ESRD patients, compared with HCs, exhibit reduced FC specifically within the cortical hubs and between the DMN hubs and two subsystems (the dMPFC and MTL subsystems). Moreover, the FC values between the aMPFC and PCC were positively correlated with creatinine and urea levels in the ESRD patients. Our results suggest that the cortical hubs (PCC and aMPFC) are preferentially disrupted and that other subsystems may be progressively damaged to a certain degree as the disease develops.
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Affiliation(s)
- Chi Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fen Tian
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min-Ge Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hua-Wei Su
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian-Cong Fan
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao, China
| | - Zhan-Hui Li
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao, China
| | - Yan-de Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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32
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Wu B, Li X, Zhang M, Zhang F, Long X, Gong Q, Jia Z. Disrupted brain functional networks in patients with end-stage renal disease undergoing hemodialysis. J Neurosci Res 2020; 98:2566-2578. [PMID: 32930417 DOI: 10.1002/jnr.24725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023]
Abstract
Patterns of change in whole-brain functional networks remain poorly understood in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). We conducted a prospective research to investigate the topological properties of whole-brain functional networks in those patients using a graph-based network analysis. Resting-state functional magnetic resonance imaging was performed on 51 ESRD patients (25 HD and 26 nondialysis patients) and 36 healthy controls (HCs). We compared the topological properties of brain functional networks among the three groups, and analyzed the relationships between those significant parameters and clinical variables in ESRD patients. Progressively disrupted global topological organizations were observed from nondialysis patients to HD patients compared with HCs (all p < 0.05 after Bonferroni correction). HD patients, relative to HCs, showed significantly decreased nodal centralities in the left temporal pole: superior temporal gyrus, bilateral median cingulate and paracingulate gyri, bilateral hippocampus, bilateral parahippocampal gyrus, and bilateral amygdala, and showed increased nodal centralities in the orbital part of the bilateral middle frontal gyrus, left cuneus, and left superior occipital gyrus (all p < 0.05 after Bonferroni correction). Furthermore, nodal centralities in the bilateral hippocampus were significantly decreased in HD patients compared with nondialysis patients (p < 0.05 after Bonferroni correction). Dialysis duration negatively correlated with global efficiency in ESRD patients undergoing HD (r = -0.676, FDR q = 0.004). This study indicates that ESRD patients exhibit disruptions in brain functional networks, which are more severe in HD patients, and these alterations are correlated with cognitive performance and clinical markers.
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Affiliation(s)
- Baolin Wu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui, PR China
| | - Xuekun Li
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui, PR China
| | - Meng Zhang
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui, PR China
| | - Feifei Zhang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Xipeng Long
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), Chengdu, PR China
| | - Zhiyun Jia
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
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33
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Chen HJ, Qiu J, Fu Q, Chen F. Alterations of Spontaneous Brain Activity in Hemodialysis Patients. Front Hum Neurosci 2020; 14:278. [PMID: 32765243 PMCID: PMC7381103 DOI: 10.3389/fnhum.2020.00278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is prevalent in hemodialysis end-stage renal disease (ESRD) patients. It might be associated with poor prognosis. Nevertheless, the underlying mechanisms have not been completely clarified. This study explored spontaneous brain activity in ESRD patients on hemodialysis by using the amplitude of low-frequency fluctuation (ALFF). Nineteen ESRD patients on regular hemodialysis were included in this study. Eighteen age-, sex- and education level-matched volunteers were enrolled as the healthy control group. All participants had resting-state functional MRI scanning, neuropsychological tests, and laboratory testing. ALFF was used for assessing intrinsic brain activity. Independent samples t-test was used for obtaining group differences. Spearman correlation analysis was applied to assess the association between ALFF changes, neuropsychological, and clinical indices. Compared to the healthy control group, hemodialysis patients showed decreased ALFF in the precuneus, right angular gyrus/inferior lobule as well as increased ALFF in the left parahippocampus/hippocampus and right precentral/postcentral gyrus. The ALFF abnormalities in these regions were closely associated with hemoglobin levels. Also, increased ALFF in the left parahippocampus/hippocampus showed a negative correlation with the score of long-delayed free recall. Hemodialysis patients had aberrant ALFF in the default mode network (DMN) regions, particularly in the precuneus and parahippocampus/hippocampus, which may be correlated with neuropathological mechanisms involved in hemodialysis.
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Affiliation(s)
- Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jie Qiu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Qingqing Fu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of University of South China), Haikou, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
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Peng C, Yang H, Ran Q, Zhang L, Liu C, Fang Y, Liu Y, Cao Y, Liang R, Ren H, Hu Q, Mei X, Jiang Y, Luo T. Immediate Abnormal Intrinsic Brain Activity Patterns in Patients with End-stage Renal Disease During a Single Dialysis Session : Resting-state Functional MRI Study. Clin Neuroradiol 2020; 31:373-381. [PMID: 32601841 DOI: 10.1007/s00062-020-00915-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/12/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate cerebral amplitude of low-frequency fluctuations (ALFF) changes during a single hemodialysis (HD) in end-stage renal disease (ESRD) patients who need maintenance HD. MATERIALS AND METHODS A total of 24 patients and 27 healthy subjects were included. The patients underwent neuropsychological tests and took twice resting-state fMRI (rs-fMRI) (before and after HD). Healthy group had one rs-fMRI. The zALFF based on rs-fMRI was calculated. Paired t and independent t test was applied to compare zALFF among groups. The associations between zALFF and duration of HD, ultrafiltration volume, and neuropsychological tests was calculated by partial correlation. RESULTS Compared to healthy group, patients before HD showed significant worse performances on digit symbol test (DST) and serial dotting test (SDT). Patients after HD performed DST better than before HD. The patients after HD showed higher zALFF in left putamen than before HD. Multiple regions of both HD groups showed significant lower zALFF than healthy group. The zALFF of left putamen of patients after HD was significant negative correlated with the ultrafiltration volume (R = -0.679). The zALFF in patients before HD exhibited significantly positive or negative correlations with DST and SDT in multiple regions. The zALFF of patients after HD significantly negative correlated with DST in right temporal, positive and negative correlated with ultrafiltration volume in right frontal, left putamen respectively. CONCLUSION ESRD patients showed changed spontaneous brain activity and cognitive impairments. After a single HD session, patients performed better in neuropsychological test, and spontaneous brain activity changed in left putamen. Ultrafiltration volume might be associated with activity of left putamen.
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Affiliation(s)
- Cong Peng
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, 400016, Chongqing, Yuzhong District, China.,Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Hua Yang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Qian Ran
- Department of Radiology, Xin Qiao Hospital, Chongqing, China.,Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium
| | - Ling Zhang
- Department of Nephrology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Chengxuan Liu
- Department of Nephrology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yu Fang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yingjiang Liu
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yi Cao
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Renrong Liang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - He Ren
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Qinqin Hu
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Xiuting Mei
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yang Jiang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Tianyou Luo
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, 400016, Chongqing, Yuzhong District, China.
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35
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Jin M, Wang L, Wang H, Han X, Diao Z, Guo W, Yang Z, Ding H, Wang Z, Zhang P, Zhao P, Lv H, Liu W, Wang Z. Disturbed neurovascular coupling in hemodialysis patients. PeerJ 2020; 8:e8989. [PMID: 32328355 PMCID: PMC7166048 DOI: 10.7717/peerj.8989] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Altered cerebral blood flow (CBF) and amplitude of low-frequency fluctuation (ALFF) have been reported in hemodialysis patients. However, neurovascular coupling impairments, which provide a novel insight into the human brain, have not been reported in hemodialysis patients. Methods We combined arterial spin labeling (ASL) and blood oxygen level dependent (BOLD) techniques to investigate neurovascular coupling alterations and its relationships with demographic and clinical data in 46 hemodialysis patients and 47 healthy controls. To explore regional neuronal activity, ALFF was obtained from resting-state functional MRI. To measure cerebral vascular response, CBF was calculated from ASL. The across-voxel CBF-ALFF correlations for global neurovascular coupling and CBF/ALFF ratio for regional neurovascular coupling were compared between hemodialysis patients and healthy controls. Two-sample t-tests were used to compare the intergroup differences in CBF and ALFF. Multiple comparisons were corrected using a voxel-wise false discovery rate (FDR) method (P < 0.05). Results All hemodialysis patients and healthy controls showed significant across-voxel correlations between CBF and ALFF. Hemodialysis patients showed a significantly reduced global CBF-ALFF coupling (P = 0.0011) compared to healthy controls at the voxel-level. Of note, decreased CBF/ALFF ratio was exclusively located in the bilateral amygdala involved in emotional regulation and cognitive processing in hemodialysis patients. In hemodialysis patients, the decreased CBF (right olfactory cortex, anterior cingulate gyrus and bilateral insula) and ALFF (bilateral precuneus and superior frontal gyrus) were mainly located in the default mode network and salience network-related regions as well as increased CBF in the bilateral thalamus. Conclusions These novel findings reveal that disrupted neurovascular coupling may be a potential neural mechanism in hemodialysis patients.
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Affiliation(s)
- Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liyan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Chen HJ, Wang YF, Wen J, Xu Q, Lu GM, Zhang LJ. Functional-structural relationship in large-scale brain networks of patients with end stage renal disease after kidney transplantation: A longitudinal study. Hum Brain Mapp 2020; 41:328-341. [PMID: 31571368 PMCID: PMC7268055 DOI: 10.1002/hbm.24804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
It is unclear how the brain network changed after kidney transplantation (KT). We explored the patterns of large‐scale complex network after KT in end‐stage renal disease (ESRD) patients with resting‐state functional MRI (rs‐fMRI) and diffusion tensor imaging (DTI). Twenty‐one ESRD patients (14 men; mean age, 31.5 ± 9.9 years) scheduled for KT and 17 age‐ and gender‐matched healthy controls (HC) (8 men; mean age, 28.9 ± 7.2 years) were enrolled in this study. Each participant underwent rs‐fMRI and DTI scans in three time points (pre‐KT, 1 and 6 months after KT [for ESRD]). Graph theory analysis was used to characterize the topological properties by using functional and structural network connectivities intergroup correlation analysis was performed between functional/structural MR indexes and clinical markers. Compared with HC, pre‐KT ESRD patients showed an altered topological organization in both functional and structural networks. Compared with pre‐KT, increased node degree and node efficiency were observed for both functional and structural networks at 1 month after KT (all p < .05), which were further increased at 6 months after KT (p < .05). Both functional and structural networks did not recover completely at 6 months after KT (all p < .05). The patients showed an increased functional–structural connectivity coupling at 1 month after KT compared with HC (p = .041). A trend of progressive recovery of functional and structural connectivity networks was observed in ERSD patients after KT, which did not recover to the normal levels even in 6 months after KT. The study results underlie cognitive function recovery in ESRD patients following KT in the neuropathophysiological perspective.
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Affiliation(s)
- Hui J Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.,Department of Radiology, Affiliated Hainan Hospital of Hainan Medical College, Hainan General Hospital, Haikou, Hainan, P.R. China
| | - Yun F Wang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Guang M Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Long J Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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37
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Wang YF, Zheng LJ, Liu Y, Ye YB, Luo S, Lu GM, Gong D, Zhang LJ. The gut microbiota-inflammation-brain axis in end-stage renal disease: perspectives from default mode network. Am J Cancer Res 2019; 9:8171-8181. [PMID: 31754388 PMCID: PMC6857049 DOI: 10.7150/thno.35387] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022] Open
Abstract
The gut-brain axis in end-stage renal disease (ESRD) is attracting more and more attention. However, the mechanism of gut-brain axis based cognitive disorders in ESRD patients remains unclear. The purpose of this study was to investigate the linkages between the gut microbiota, inflammatory cytokines, brain default mode network (DMN) and cognitive function in ESRD patients. Methods: This prospective study enrolled 28 ESRD patients (13 males and 15 females, mean age of 44 ± 14 years) and 19 healthy controls (HCs) (12 males and 7 females, mean age of 44 ± 10 years). All subjects underwent stool microbiota analysis, blood inflammatory cytokines examination, brain MRI scans and cognitive assessments. Resting state functional MRI (rs-fMRI) data were used to construct DMN and graph theory was applied to characterize network topological properties. Two samples t-test was applied for the comparisons between ESRD and HCs. Correlation analysis and mediation analysis were conducted among factors with significant group differences. Results: ESRD patients displayed gut microbiota alterations, increased systemic inflammation and worse cognitive performance compared to HCs (all p < 0.05). Graph analysis revealed disrupted DMN topological organization, aberrant nodal centralities and functional connectivities (FCs) in ESRD patients relative to HCs (all p < 0.05, FDR corrected). Significant correlations were found between gut microbiota, inflammatory cytokines, DMN network measures and cognitive assessments. Mediation analysis found that gut microbiota alteration impaired DMN connectivity by increasing systemic inflammation. Conclusion: The present study first revealed gut microbiota alterations, systemic inflammation, DMN dissociation and cognitive dysfunction in ESRD patients simultaneously and further illuminated their inner relationship.
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Lu H, Gu Z, Xing W, Han S, Wu J, Zhou H, Ding J, Zhang J. Alterations of default mode functional connectivity in individuals with end-stage renal disease and mild cognitive impairment. BMC Nephrol 2019; 20:246. [PMID: 31277581 PMCID: PMC6612101 DOI: 10.1186/s12882-019-1435-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) occurs frequently in many end stage renal disease (ESRD) patients, may significantly worsen survival odds and prognosis. However, the exact neuropathological mechanisms of MCI combined with ESRD are not fully clear. This study examined functional connectivity (FC) alterations of the default-mode network (DMN) in individuals with ESRD and MCI. METHODS Twenty-four individuals with ESRD identified as MCI patients were included in this study; of these, 19 and 5 underwent hemodialysis (HD) and peritoneal dialysis (PD), respectively. Another group of 25 age-, sex- and education level-matched subjects were recruited as the control group. All participants underwent resting-state functional MRI and neuropsychological tests; the ESRD group underwent additional laboratory testing. Independent component analysis (ICA) was used for DMN characterization. With functional connectivity maps of the DMN derived individually, group comparison was performed with voxel-wise independent samples t-test, and connectivity changes were correlated with neuropsychological and clinical variables. RESULTS Compared with the control group, significantly decreased functional connectivity of the DMN was observed in the posterior cingulate cortex (PCC) and precuneus (Pcu), as well as in the medial prefrontal cortex (MPFC) in the ESRD group. Functional connectivity reductions in the MPFC and PCC/Pcu were positively correlated with hemoglobin levels. In addition, functional connectivity reduction in the MPFC showed positive correlation with Montreal Cognitive Assessment (MoCA) score. CONCLUSION Decreased functional connectivity in the DMN may be associated with neuropathological mechanisms involved in ESRD and MCI.
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Affiliation(s)
- Haitao Lu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhengzhang Gu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Shanhua Han
- Department of Radiology, Shanghai Fourth People's Hospital, Shanghai, China
| | | | - Hua Zhou
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jiule Ding
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jinggang Zhang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Cheng BC, Chen PC, Chen PC, Lu CH, Huang YC, Chou KH, Li SH, Lin AN, Lin WC. Decreased cerebral blood flow and improved cognitive function in patients with end-stage renal disease after peritoneal dialysis: An arterial spin-labelling study. Eur Radiol 2019; 29:1415-1424. [PMID: 30105409 PMCID: PMC6510858 DOI: 10.1007/s00330-018-5675-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. METHODS ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group. Comparisons of regional CBF between ESRD patients before or after undergoing PD and normal controls were performed. Correlations between biochemical, neuropsychological and CBF data were also conducted to evaluate the relationships. RESULTS ESRD patients showed poor performance in many of the neuropsychological tests; PD improved cognition in some domains. Pre-PD patients had higher mean CBF than post-PD patients and normal controls, but no significant difference was found between the normal controls and post-PD patients. Negative correlations were observed pre-PD (regional CBF in left hippocampus vs. perseverative responses, r = -0.662, p = 0.014), post-PD (mean CBF vs. haemoglobin level, r = -0.766, p = 0.002), and before and after PD (change in CBF in the left putamen vs. change in haematocrit percentage, r = -0.808, p = 0.001). CONCLUSION Before PD, ESRD patients had increased cerebral perfusion that was related to poorer executive function, especially in the left hippocampus. Post-PD patients performed better in some cognitive test domains than pre-PD patients. The degree of anaemia, i.e., haemoglobin level or haematocrit percentage, might predict cognitive impairment in PD patients. KEY POINTS • In this study, ESRD patients before PD had cerebral hyperperfusion that was related to poorer executive function. • Post-PD patients performed better in some cognitive test domains than pre-PD patients did. • The degree of anaemia might predict cognitive impairment in PD patients.
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Affiliation(s)
- Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Shau-Hsuan Li
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan.
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Mu J, Chen T, Li P, Ding D, Ma X, Zhang M, Liu J. Altered white matter microstructure mediates the relationship between hemoglobin levels and cognitive control deficits in end-stage renal disease patients. Hum Brain Mapp 2018; 39:4766-4775. [PMID: 30062855 DOI: 10.1002/hbm.24321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022] Open
Abstract
The brain-kidney crosstalk theory suggested that the brain and kidneys may be considered end organs on parallel trajectories and subject to shared risk factors, which are receiving increasing attention. Cognitive control deficits were frequently presented in patients with end-stage renal disease (ESRD). Whether or not cognitive control impairment is concerned with brain-kidney crosstalk is in need of further research. To detect the relationship between ESRD and cognitive control impairment, diffusion tensor imaging was collected in 64 healthy controls (HCs) and 64 patients with ESRD. Tract-based spatial statistics and fixel-based analysis were used to detect the difference of white matter (WM) microstructure and morphology between ESRD patients and HCs in the whole brain. Tractography atlas-based analysis was also used to investigate the difference of diffusional characteristics along fiber bundles of interest between the two groups. For the whole-brain analysis, ESRD patients showed WM microstructural alteration and fiber density variation in the cingulum. In addition, ESRD patients exhibited higher MD and RD than HCs along the anterior cingulum. Among all of the blood biochemistry tests that represent kidney disease to a degree, the stepwise regression analysis showed that only hemoglobin significantly contributed to the cognitive control deficits in ESRD patients. Mediation analysis proved that the relationship between hemoglobin and cognitive control deficits of ESRD patients was mediated by WM microstructural alteration of the cingulum. Our results indicated that the anterior cingulum was correlated with cognitive control deficits and mediated the impact of hemoglobin on cognitive control.
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Affiliation(s)
- Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, People's Republic of China
| | - Tao Chen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, People's Republic of China
| | - Peng Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Dun Ding
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xueying Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, People's Republic of China
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Liu HS, Hartung EA, Jawad AF, Ware JB, Laney N, Port AM, Gur RC, Hooper SR, Radcliffe J, Furth SL, Detre JA. Regional Cerebral Blood Flow in Children and Young Adults with Chronic Kidney Disease. Radiology 2018; 288:849-858. [PMID: 29893643 DOI: 10.1148/radiol.2018171339] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose To investigate the pathophysiologic effects of chronic kidney disease (CKD) on brain function in children with CKD by correlating cerebral blood flow (CBF) with clinical and behavioral indexes. Materials and Methods In this prospective study, 73 pediatric patients with CKD (mean age, 15.80 years ± 3.63; range, 9-25 years) and 57 control subjects (mean age, 15.65 years ± 3.76; range, 9-25 years) were recruited. CBF measurements were acquired with an MRI arterial spin labeling scheme. Neurocognitive measurements were performed with traditional and computerized neurocognitive batteries. Clinical data were also collected. Group-level global and regional CBF differences between patients with CKD and control subjects were assessed. Regression analyses were conducted to evaluate the associations among regional CBF, clinical variables, and cognitive performance. Results Patients with CKD showed higher global CBF compared with control subjects that was attributable to reduced hematocrit level (mean, 60.2 mL/100 g/min ± 9.0 vs 56.5 mL/100 g/min ± 8.0, respectively). White matter CBF showed correlation with blood pressure (r = 0.244, P = .039), a finding suggestive of altered cerebrovascular autoregulation. Regional CBF differences between patients and control subjects included regions in the "default mode" network. In patients with CKD, positive extrema in the precuneus showed a strong correlation with executive function (ρ = 0.608, P = .001). Conclusion Systemic effects of estimated glomerular filtration rate, hematocrit level, and blood pressure on CBF and alterations in regional CBF may reflect impaired brain function underlying neurocognitive symptoms in CKD. These findings further characterize the nature of alterations in brain physiologic features in children, adolescents, and young adults with CKD.
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Affiliation(s)
- Hua-Shan Liu
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Erum A Hartung
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Abbas F Jawad
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Jeffrey B Ware
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Nina Laney
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Allison M Port
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Ruben C Gur
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Stephen R Hooper
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Jerilynn Radcliffe
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Susan L Furth
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - John A Detre
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
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Li P, Ding D, Ma XY, Zhang HW, Liu JX, Zhang M. Altered intrinsic brain activity and memory performance improvement in patients with end-stage renal disease during a single dialysis session. Brain Imaging Behav 2018; 12:1640-1649. [DOI: 10.1007/s11682-018-9828-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Chen HJ, Wen J, Qi R, Zhong J, Schoepf UJ, Varga-Szemes A, Lesslie VW, Kong X, Wang YF, Xu Q, Zhang Z, Li X, Lu GM, Zhang LJ. Re-Establishing Brain Networks in Patients with ESRD after Successful Kidney Transplantation. Clin J Am Soc Nephrol 2018; 13:109-117. [PMID: 29046290 PMCID: PMC5753300 DOI: 10.2215/cjn.00420117] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognition in ESRD may be improved by kidney transplantation, but mechanisms are unclear. We explored patterns of resting-state networks with resting-state functional magnetic resonance imaging among patients with ESRD before and after kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Thirty-seven patients with ESRD scheduled for kidney transplantation and 22 age-, sex-, and education-matched healthy subjects underwent resting-state functional magnetic resonance imaging. Patients were imaged before and 1 and 6 months after kidney transplantation. Functional connectivity of seven resting-state subnetworks was evaluated: default mode network, dorsal attention network, central executive network, self-referential network, sensorimotor network, visual network, and auditory network. Mixed effects models tested associations of ESRD, kidney transplantation, and neuropsychological measurements with functional connectivity. RESULTS Compared with controls, pretransplant patients showed abnormal functional connectivity in six subnetworks. Compared with pretransplant patients, increased functional connectivity was observed in the default mode network, the dorsal attention network, the central executive network, the sensorimotor network, the auditory network, and the visual network 1 and 6 months after kidney transplantation (P=0.01). Six months after kidney transplantation, no significant difference in functional connectivity was observed for the dorsal attention network, the central executive network, the auditory network, or the visual network between patients and controls. Default mode network and sensorimotor network remained significantly different from those in controls when assessed 6 months after kidney transplantation. A relationship between functional connectivity and neuropsychological measurements was found in specific brain regions of some brain networks. CONCLUSIONS The recovery patterns of resting-state subnetworks vary after kidney transplantation. The dorsal attention network, the central executive network, the auditory network, and the visual network recovered to normal levels, whereas the default mode network and the sensorimotor network did not recover completely 6 months after kidney transplantation. Neural resting-state functional connectivity was lower among patients with ESRD compared with control subjects, but it significantly improved with kidney transplantation. Resting-state subnetworks exhibited variable recovery, in some cases to levels that were no longer significantly different from those of normal controls.
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Affiliation(s)
- Hui Juan Chen
- Department of Medical Imaging and
- Department of Radiology, Hainan General Hospital, Haikou, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | | | - Jianhui Zhong
- Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China; and
| | - U. Joseph Schoepf
- Department of Medical Imaging and
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Virginia W. Lesslie
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Qiang Xu
- Department of Medical Imaging and
| | - Zhe Zhang
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xue Li
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Yin Y, Li M, Li C, Ma X, Yan J, Wang T, Fu S, Hua K, Wu Y, Zhan W, Jiang G. Reduced White Matter Integrity With Cognitive Impairments in End Stage Renal Disease. Front Psychiatry 2018; 9:143. [PMID: 29725309 PMCID: PMC5917068 DOI: 10.3389/fpsyt.2018.00143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/03/2018] [Indexed: 12/11/2022] Open
Abstract
Background: End-stage renal disease (ESRD) is a serious public health problem, which can often lead to multiorgan dysfunction, such as cerebrovascular disease and cognitive damage. It is essential to understand cognitive impairment in patients with ESRD to develop better ESRD treatment and prevent further cognitive impairment. Cognitive impairment is believed to be related to structural abnormalities in the brain. Purpose: To investigate white matter microstructural abnormalities in patients with ESRD using TBSS analysis of DTI and to explore the possible mechanisms underlying the impaired cognitive function. Materials and Methods: A TBSS analysis of DTI data was to investigate the microstructural changes in their WM over the whole brain. We chose the white matter tracts or regions with significantly reduced FA as the regions of interest (ROIs), Pearson's correlations were performed between clinical indicators (Mini-Mental State Examination (MMSE), digit span task scores, serum creatinine, blood urea nitrogen and hemodialysis duration) and the mean FA value of the ROIs in the ESRD patients. Results: Lower FA and higher MD, AD and RD values were observed in widespread and symmetrical WM in ESRD patients than healthy controls (HCs), Pearson correlation analysis revealed a significantly positive correlation between the Mini-Mental State Examination (MMSE) scores and FA values in the right corona radiata and left anterior thalamic radiation (ATR) and demonstrated a significantly negative correlation between FA values and the serum creatinine and blood urea nitrogen in the ATR (P < 0.01) in addition, digit span task scores positively correlate with the FA value in the left anterior rather than in the corona radiata. No cluster survived when we adopted the False Discovery Rate (FDR) correction to multiple comparisons. Conclusion: Our study indicate widespread impairment of the white matter in ESRD patients. Damage to the thalamic radiation and corona radiata may affect cognitive function in ESRD patients, the reduced integrity of ATR may tend to affect the working memory while the damage to the corona radiata may involve the executive function impaired in ESRD patients. The accumulation of serum creatinine and blood urea nitrogen may contribute to the WM impairment.
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Affiliation(s)
- Yi Yin
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meng Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chao Li
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaofen Ma
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianhao Yan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shishun Fu
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Kelei Hua
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yunfan Wu
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wenfeng Zhan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
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Ma X, Tian J, Wu Z, Zong X, Dong J, Zhan W, Xu Y, Li Z, Jiang G. Spatial Disassociation of Disrupted Functional Connectivity for the Default Mode Network in Patients with End-Stage Renal Disease. PLoS One 2016; 11:e0161392. [PMID: 27560146 PMCID: PMC4999135 DOI: 10.1371/journal.pone.0161392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the aberrant functional connectivity of the default mode network (DMN) in patients with end-stage renal disease (ESRD) and their clinical relevance. MATERIALS AND METHODS Resting-state functional MRI data were collected from 31 patients with ESRD (24 men, 24-61 years) and 31 age- and gender-matched healthy controls (HCs, 21 men, 26-61years). A whole-brain seed-based functional connectivity analysis of these collected R-fMRI data was performed by locating the seeds in the posterior cingulate cortex (PCC) and ventromedial prefrontal cortex (vmPFC) to investigate the functional connectivity of the posterior and anterior DMN over the whole brain, respectively. RESULTS Compared to the HCs, the patients exhibited significantly decreased functional connectivity with the PCC in the left middle temporal gyrus, the right anterior cingulate gyrus, and the bilateral medial superior frontal gyrus. For the vmPFC seed, only the right thalamus showed significantly decreased functional connectivity in the patients with ESRD compared to HCs. Interestingly, functional connectivity between the PCC and right medial superior frontal gyrus exhibited a significantly positive correlation with the hemoglobin level in the patients. CONCLUSION Our findings suggest a spatially specific disruption of functional connectivity in the DMN in patients with ESRD, thereby providing novel insights into our understanding of the neurophysiology mechanism that underlies the disease.
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Affiliation(s)
- Xiaofen Ma
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
| | - Junzhang Tian
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
| | - Zhanhong Wu
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xiaopeng Zong
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jianwei Dong
- Department of Mathematics, Guangdong Pharmaceutical University, Guangzhou City, Guangdong province, PR China
| | - Wenfeng Zhan
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong province, PR China
| | - Zibo Li
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail: (GJ); (ZL)
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
- * E-mail: (GJ); (ZL)
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Jiang XL, Wen JQ, Zhang LJ, Zheng G, Li X, Zhang Z, Liu Y, Zheng LJ, Wu L, Chen HJ, Kong X, Luo S, Lu GM, Ji XM, Zhang ZJ. Cerebral blood flow changes in hemodialysis and peritoneal dialysis patients: an arterial-spin labeling MR imaging. Metab Brain Dis 2016; 31:929-36. [PMID: 27167984 DOI: 10.1007/s11011-016-9829-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/28/2016] [Indexed: 01/04/2023]
Abstract
We used arterial-spin labeling (ASL) MR imaging, a non-invasive technique to evaluate cerebral blood flow (CBF) changes in patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) and hemodialysis (HD), and nondialysis ESRD patients compared with healthy cohort. Ninety seven ESRD patients including 32 PD patients (20 male, 12 female; mean age 33 ± 8 years), 33 HD patients (22 male, 11 female; mean age 33 ± 8 years) and 32 nondialysis patients (20 male, 12 female; mean age 35 ± 7 years) and 31 age- and gender-matched healthy controls (20 male, 11 female; mean age 32 ± 8 years) were included in this study. All subjects underwent ASL MR imaging, neuropsychologic tests, and ESRD patients underwent laboratory testing. CBF values were compared among PD, HD, nondialysis patients and control groups. Correlation analysis and multiple regression analysis were performed to investigate the association between CBF values and hemoglobin, neuropsychologic test results, serum creatinine, urea levels, disease duration, and dialysis duration. Elevated CBFs of whole brain region, gray matter, and white matter were found in all ESRD patient groups compared with healthy controls (all P < 0.001). However, compared with non-dialysis ESRD patients, both PD and HD patients had widespread regional CBF decline mainly in bilateral frontal and anterior cingulate cortices. There were no differences for CBF between PD and HD patient groups. Negative correlations were observed between mean CBFs of whole brain region, gray matter, and white matter and the hemoglobin level in all ESRD patients. Multiple linear regression showed elevated CBF of multiple brain areas correlated with some neuropsychological tests in ESRD patients (all P < 0.001, AlphaSim corrected), but the association was not present or shrank after adjusting hemoglobin level. This study found that mean CBF was predominantly increased in patients with ESRD, which correlated with their hemoglobin level and neurocognitive disorders. There were no differences of CBF change and cognitive function between PD and HD ESRD patients with long-term treatment. The degree of anemia may be a predominant risk factor for cognitive impairment in these ESRD patients.
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Affiliation(s)
- Xiao Lu Jiang
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Ji Qiu Wen
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Gang Zheng
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
- College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China.
| | - Xue Li
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zhe Zhang
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Ya Liu
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
- College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China
| | - Li Juan Zheng
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Long Wu
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Hui Juan Chen
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Xiang Kong
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Song Luo
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Xue Man Ji
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
| | - Zong Jun Zhang
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
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PET/MRI of central nervous system: current status and future perspective. Eur Radiol 2016; 26:3534-41. [PMID: 26780640 DOI: 10.1007/s00330-015-4202-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/15/2015] [Accepted: 12/30/2015] [Indexed: 12/18/2022]
Abstract
UNLABELLED Imaging plays an increasingly important role in the early diagnosis, prognosis prediction and therapy response evaluation of central nervous system (CNS) diseases. The newly emerging hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) can perform "one-stop-shop" evaluation, including anatomic, functional, biochemical and metabolic information, even at the molecular level, for personalised diagnoses and treatments of CNS diseases. However, there are still several problems to be resolved, such as appropriate PET detectors, attenuation correction and so on. This review will introduce the basic physical principles of PET/MRI and its potential clinical applications in the CNS. We also provide the future perspectives for this field. KEY POINTS • PET/MRI can simultaneously provide anatomic, functional, biochemical and metabolic information. • PET/MRI has promising potential in various central nervous system diseases. • Research on the future implementation of PET/MRI is challenging and encouraging.
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Zhang XD, Wen JQ, Xu Q, Qi R, Chen HJ, Kong X, Wei LD, Xu M, Zhang LJ, Lu GM. Altered long- and short-range functional connectivity in the patients with end-stage renal disease: a resting-state functional MRI study. Metab Brain Dis 2015; 30:1175-86. [PMID: 26016622 DOI: 10.1007/s11011-015-9683-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/11/2015] [Indexed: 01/10/2023]
Abstract
To investigate alterations of functional connectivity density (FCD) in patients with end-stage renal disease (ESRD) by using resting-state functional magnetic resonance imaging (rs-fMRI). Medical research ethics committee approval from Jinling hospital and written informed consent from each subject were obtained. Forty six patients with ESRD, consisting of 21 patients minimal nephrotic encephalopathy (MNE) and 25 non-nephro-encephalopathy (non-NE), as well as 23 healthy controls underwent rs-fMRI. Neuropsychological tests were performed in all subjects, while laboratory tests were performed in ESRD patients. A voxel-wise whole brain functional connectivity analysis was used to generate long- and short-range FCD maps. The maps among MNE, non-NE, and healthy controls groups were compared by using one-way analysis of variance tests. A multiple regression analysis was performed to evaluate the correlations between FCD and the variables of neuropsychological or laboratory tests. Compared with healthy controls, non-NE showed decreased long-range FCD mainly in parietal lobe. Moreover, MNE showed further decreased long-range FCD in bilateral middle prefrontal cortex (MPFC), anterior cingulate cortex (ACC) and right superior frontal gyrus. Meanwhile, non-NE showed decreased short-range FCD mainly in frontal cortex, and further reduction in bilateral ACC and right superior parietal gyrus in MNE. In addition, patients with ESRD mainly exhibited increased long-range FCD in left temporal lobe and caudate; and increased short-range FCD in bilateral orbitofrontal cortex and temporal gyri (P < 0.05, AlphaSim corrected). The number connection test type A score, serum creatinine, urea, and dialysis duration showed negative correlation with FCD in some brain regions, while the digital symbol test scores positively correlated with short-range FCD in left inferior parietal lobule (all P < 0.05, AlphaSim corrected). The prominent long- and short-range FCD reduction was found mainly in default mode network (DMN) and bilateral frontal and parietal lobes, while the progressively decreased long- and short-range FCD in ACC/MPFC and the long-range FCD in left superior frontal gyrus from non-NE to MNE was associated with cognition dysfunction in ESRD patients.
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Affiliation(s)
- Xiao-Dong Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, Jiangsu Province, 210002, China
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Chen HJ, Qi R, Kong X, Wen J, Liang X, Zhang Z, Li X, Lu GM, Zhang LJ. The impact of hemodialysis on cognitive dysfunction in patients with end-stage renal disease: a resting-state functional MRI study. Metab Brain Dis 2015; 30:1247-56. [PMID: 26146033 DOI: 10.1007/s11011-015-9702-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/22/2015] [Indexed: 12/31/2022]
Abstract
To investigate the effect of hemodialysis (HD) on cognitive dysfunction in patients with end-stage renal disease (ESRD) using resting-state functional MR imaging (rs-fMRI) with regional homogeneity (ReHo) and functional connectivity algorithms. The rs-fMRI data were acquired in 58 ESRD patients (HD patients, n = 32, 22 male and 10 female, mean age 36.5 ± 9.6 years; non-HD ESRD patients, n = 26, 16 male and 10 female, mean years of 35.6 ± 8.2) and 32 healthy controls (22 male and 10 female, mean years of 32.7 ± 8.8). A battery of neuropsychological and blood laboratory tests were prescribed. The Kendall's coefficient of concordance (KCC) was used to measure ReHo for each subject. The ReHo maps were compared by using ANOVA tests among HD, non-HD, and healthy control groups. Regions showing ReHo differences between HD and non-HD patients were defined as seeds for further functional connectivity analysis. A multiple regression analysis was performed to evaluate the relationships between ReHo index and neuropsychological tests, serum creatinine and urea levels, disease and dialysis duration. Compared with healthy controls, both HD patients and non-HD patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-HD, HD patients showed decreased ReHo mainly in default mode network (DMN) including bilateral precuneus, posterior cingulate cortex, inferior parietal lobe, right postcentral gyrus, bilateral superior temporal gyri, right supramarginal gyrus and right angular gyrus. Some reduced ReHo brain regions correlated with some neuropsychological tests, serum creatinine and urea levels, and dialysis duration. Brain regions with ReHo reduction showed increased region-to-region functional network in HD patients compared with non-HD patients. Widespreadly decreased ReHo values were found in both HD and non-HD patients. Lower ReHo values mainly in the DMN correlated with cognition impairments were observed in HD patients compared with non-HD patients, while increased functional connectivity was found between these brain regions. HD might have an adverse effect on the cognitive function in ESRD patients.
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Affiliation(s)
- Hui Juan Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
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Zhang LJ, Wen J, Liang X, Qi R, Schoepf UJ, Wichmann JL, Milliken CM, Chen HJ, Kong X, Lu GM. Brain Default Mode Network Changes after Renal Transplantation: A Diffusion-Tensor Imaging and Resting-State Functional MR Imaging Study. Radiology 2015. [PMID: 26200603 DOI: 10.1148/radiol.2015150004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate structural and functional alterations of the default mode network (DMN) in the brain after renal transplantation in patients with end-stage renal disease by using diffusion-tensor imaging and resting-state functional MR imaging. MATERIALS AND METHODS This prospective study was approved by the local medical research ethics committee, and written informed consent was obtained. Twenty-one patients with end-stage renal disease (15 men, six women; mean age ± standard deviation, 32 years ± 9.5) who were scheduled to undergo renal transplantation and 21 healthy control subjects (15 men, six women; mean age, 31 years ± 6.5) were included. Diffusion-tensor imaging and resting-state functional MR imaging were performed in all subjects. Patients were imaged both before and 1 month after renal transplantation. Structural (mean diffusivity, fractional anisotropy, path length, and number of tracts derived from diffusion-tensor imaging tractography) and functional (temporal correlation coefficient derived from resting-state functional MR imaging) connectivity of the DMN were quantitatively compared with two-sample t tests or paired t tests. Intergroup correlation analysis was performed to compare structural or functional indexes and results of neuropsychological or blood biochemistry tests. RESULTS Mean diffusivity was decreased in the fiber bundles connecting the posterior cingulate cortex and the precuneus to the bilateral inferior parietal lobules in patients after renal transplantation compared with that in patients before transplantation (P < .05). Temporal correlation coefficients for patients after renal transplantation nearly reached the levels of those for control subjects (all, P > .05). The change in mean diffusivity of the fiber bundles connecting the posterior cingulate cortex and the precuneus to the right inferior parietal lobule positively correlated with the change in hematocrit levels (r = 0.522, P = .015), the change in temporal correlation coefficients between the posterior cingulate cortex or precuneus and left or right inferior parietal lobules correlated with changes in number connection test type A scores (r = -0.549, P = .010) and digit symbol test scores (r = 0.533, P = .013). CONCLUSION Functional connectivity changes in the DMN, which were associated with improved hematocrit levels and cognitive function, may recover earlier than structural connectivity changes do 1 month after renal transplantation.
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Affiliation(s)
- Long Jiang Zhang
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Jiqiu Wen
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Xue Liang
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Rongfeng Qi
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - U Joseph Schoepf
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Julian L Wichmann
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Cole M Milliken
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Hui Juan Chen
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Xiang Kong
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Guang Ming Lu
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
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