Lower Cerebrovascular Reactivity Contributed to White Matter Hyperintensity-Related Cognitive Impairment: A Resting-State Functional MRI Study
Lower Cerebrovascular Reactivity Contributed to White Matter Hyperintensity-Related Cognitive Impairment: A Resting-State Functional MRI Study
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脑血管反应性降低导致白质高信号相关认知障碍：一项静息态功能 MRI 研究
DOI：
10.1002/jmri.27376
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发表时间：
2020-09-29
影响因子：
4.4
通讯作者：
Xu, Yun
中科院分区：
文献类型：
--
作者：
Ni, Ling;Zhang, Bing;Xu, Yun
背景：脑血管反应性受损（CVR）在白色高信号（WMH）的病理生理学中起重要作用。CVR在WMH相关认知损害（CI）发展中的发病机制仍知之甚少。目的：通过使用静息态血氧水平依赖（BOLD）方法检测WMH伴/不伴CI受试者的CVR状态，并探讨CVR、WMH和认知水平之间的中介关系。研究类型：前瞻性。受试者：中重度WMH受试者方法：采用梯度回波平面成像和3D液体衰减反转恢复技术，对68例脑梗死患者（CI组）和63例无脑梗死患者（WMH组）及87例正常对照者（NC组）进行CVR、WMH体积和认知功能评估。使用从静息状态功能MRI数据获得的BOLD信号推导出CVR图。统计学检验比较三组之间的CVR图。进行偏相关分析，将受损的CVR与WMH体积和认知测试分数相关联。结果：与正常对照组相比，WMH组左半球CVR均降低（P< 0.05）; WMH-CI组与WMH-no-CI组相比，左侧额叶CVR进一步降低（P< 0.05）。WMH-CI组左额叶CVR较低，与一般认知（r =0.311）、执行功能（r =0.362）和信息处理速度（r =0.399）相关（均P < 0.05）。室周WMH（PWMH）容积介导了这些相关性，β和95% bootstrap置信区间为（0.5097，[0.1498，1.1385]），（-0.4081，[-1.0256，-0.1363]），和（-0.5576，[-1.4666，-0.1538]）。数据结论：WMH-CI受试者在左额叶区域的静息状态BOLD方法中CVR的降低幅度大于WMH-no-CI受试者。认知功能高度依赖于脑血管反应性的完整性，并由PWMH负荷介导。证据等级：4技术有效性：2期
Background: Impaired cerebrovascular reactivity (CVR) plays an important role in the pathophysiology of white matter hyperintensities (WMHs). The pathogenesis of CVR in the development of WMH-related cognitive impairment (CI) remains poorly understood.Purpose: To detect the CVR status in WMH subjects with/without CI by using a resting-state blood oxygenation level-dependent (BOLD) approach and to explore the mediating relationships among CVR, WMH, and cognitive level.Study Type: Prospective.Subjects: Subjects with moderate to severe WMH (with CI [WMH-CI],n =68; without CI [WMH-no-CI,n =63) as well as normal controls (NCs,n =87).Field Strength/Sequence: 3.0Twith gradient-recalled echoplanar imaging and 3D fluid-attenuated inversion recovery.Assessment: The CVR, WMH volume, and cognitive level were assessed. The CVR map was derived using BOLD signal obtained from resting-state functional MRI data. Statistical Tests CVR maps were compared among the three groups. Partial correlation analyses were performed to correlate impaired CVR with WMH volume and cognitive test scores. Mediation analysis was conducted to determine whether WMH acted as a mediating factor between CVR and cognitive function.Results: Compared with the NC group, both WMH groups showed reduced CVR in the left hemisphere (P< 0.05). The WMH-CI group showed further decreased CVR in the left frontal area, when compared with the WMH-no-CI group (P< 0.05). In the WMH-CI group, the lower CVR in left frontal area was a strong indicator of poor performance on general cognition (r =0.311), executive function (r =0.362), and information processing speed (r =0.399) (allP< 0.05). Periventricular WMH (PWMH) volume mediated these correlations, the beta and 95% bootstrap confidence intervals were (0.5097, [0.1498,1.1385]), (-0.4081, [-1.0256,-0.1363]), and (-0.5576, [-1.4666,-0.1538]), respectively.Data Conclusion: WMH-CI subjects showed a greater reduction of CVR derived from a resting-state BOLD approach in the left frontal area than WMH-no-CI subjects. Cognition was highly dependent on the integrity of cerebrovascular reactivity and mediated by PWMH burden.Level of Evidence: 4Technical Efficacy: Stage 2