Diffusion tensor imaging findings in neurologically asymptomatic patients with end stage renal disease

Abstract

Various neurological problems of the brain are known to occur in patients with end stage renal disease (ESRD). However, little is known about diffusion tensor imaging (DTI) findings in patients with ESRD. Using DTI, we attempted to investigate DTI findings in patients with ESRD who showed no specific lesions on conventional brain MRI. We recruited 10 consecutive patients with ESRD for whom at least 3 years had passed since the start of peritoneal dialysis and who showed no neurological abnormality on neurologic examination. We excluded 6 patients who showed cerebral infarct (4 patients) and diabetes mellitus with peripheral neuropathy (2 patients); finally, 4 patients (39.75 ± 9.84 years) were included in this study. We evaluated hand motor function and cognition. DTI data were acquired using a 1.5-T Philips Gyroscan Intera system and diffusion tensor tractographies (DTTs) for five neural tracts (corticospinal tract, fornix, superior longitudinal fasciculus, inferior longitudinal fasciculus, and inferior fronto-occipital fasciculus) were evaluated. With the exception of 1 patient who revealed a mild abnormality at a higher cognitive function, no abnormalities in motor and cognitive function were observed. Among the 10 DTTs, except for those of the corticospinal tract, all 4 patients had more than one lesion. Patients with ESRD showed abnormalities on DTTs that were associated with cognition; however, they did not show significant cognitive abnormalities.

Aberrant Default-Mode Functional Connectivity in Patients with End-Stage Renal Disease: A Resting-State Functional MR Imaging Study

“…These findings are supported by previously published neuroimaging results focused on other imaging techniques, such as MR spectroscopy (12,36), diffusion-tensor imaging (10,37), arterial spin-labeling MR imaging and voxel-based morphometry (9). Many previous investigators have demonstrated that multiple brain regions, especially the frontal and occipital or parietal lobes, had metabolic and structural abnormalities (ie, altered metabolites, diffusion-tensor tractography, cerebral blood flow, and cerebral atrophy) with cognitive decline in clinically asymptomatic stages in patients with ESRD.…”

Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise

“…Several studies have reported a correlation between MD and FA values and neuropsychiatric testing for patients with CKD, on hemodialysis, and after transplant [50–52]. The use of advanced MRI measures such as DTI may provide a method to diagnose early risk of cognitive decline before symptom presentation [53]. Moreover, several newer MRI techniques are emerging such as multicomponent relaxometry techniques that may provide a tool to understand the etiology and the impact of risk factor contribution to cognitive decline in patients with renal disease [47, 50–55].…”

Altered Pattern of Spontaneous Brain Activity in the Patients with End-Stage Renal Disease: A Resting-State Functional MRI Study with Regional Homogeneity Analysis

“…The ESRD patients without clinical signs of overt encephalopathy showed metabolic disturbances in distinct brain regions as well as cognitive impairments [7]. Kim et al used diffusion tensor imaging and found that neurologically asymptomatic patients with ESRD had abnormalities on diffusion tensor function, tractography that were associated with cognitions, including executive function attention, memory, or visuospacial function [15]. Prohovnik et al’ study showed that ESRD patients undergoing hemodialysis have generalized cerebral atrophy and focal degeneration of the head of the caudate nucleus [16].…”