Fluid-attenuated inversion recovery magnetic resonance imaging textural features as sensitive markers of white matter damage in midlife adults

Abstract

White matter hyperintensities (WMH) are common radiological findings in ageing and a typical manifestation of cerebral small vessel disease. WMH burden is evaluated by quantifying their volume, however, subtle changes in the white matter may not be captured by WMH volumetry. In this cross-sectional study we investigated whether MRI texture of both WMH and normal appearing white matter (NAWM) was associated with reaction time, WMH volume and dementia risk in a midlife cognitively normal population. Data from 183 cognitively healthy midlife adults from the PREVENT-Dementia study (mean age 51.9 ± 5.4; 70% females) were analysed. WMH were segmented from 3 Tesla fluid-attenuated inversion recovery (FLAIR) scans using a semi-automated approach. The FLAIR images were bias field corrected and textural features (intensity mean and standard deviation, contrast, energy, entropy, homogeneity) were calculated in WMH and NAWM based on generated textural maps. Textural features were analysed for associations with WMH volume, reaction time, and the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) dementia risk score using linear regression models adjusting for age and sex. The extent of NAWM surrounding the WMH demonstrating similar textural associations to WMH was further investigated by defining layers surrounding the WMH at increments of 0.86 mm thickness. Lower mean intensity within WMH was a significant predictor of longer reaction time (t = -3.77, p < 0.01). WMH volume was predicted by textural features within WMH and NAWM, albeit in opposite directions. WMH volume was not related to reaction time, although interaction analysis revealed that participants with high WMH burden and less homogeneous WMH texture demonstrated slower reaction time. A white matter area extending 2.5-3.5 mm further from the WMH demonstrated similar associations. Higher CAIDE score was associated with a heterogeneous NAWM intensity pattern. Overall, greater homogeneity within WMH and a more heterogeneous NAWM intensity profile were connected to a higher WMH burden, while heterogeneous intensity was related to prolonged reaction time (WMH of larger volume) and dementia risk (NAWM). Our results suggest that the quantified textural measures extracted from widely used clinical scans, might capture underlying microstructural damage and might be more sensitive to early pathological changes compared to WMH volumetry.

Adherence to the Eatwell Guide and cardiometabolic, cognitive and neuroimaging parameters: an analysis from the PREVENT dementia study

“…There were no significant associations between either the binary or graded EWG scores and the CAIDE score. The CAIDE score was selected as one of the most commonly used dementia risk scores, with associations between the score and neuroimaging outcomes previously reported in the PREVENT dementia cohort [24][25][26][27][28]. Importantly the CAIDE score reflects the accumulation of cardiovascular risk for dementia, factors which may be the most amenable to dietary interventions.…”

“…The CAIDE score combines a number of non-modifiable and potentially modifiable risk factors. It was selected as it has previously been associated with a number of neuroimaging outcomes in the PREVENT dementia cohort [24][25][26][27][28]. Additionally, the CAIDE score has been suggested as an appropriate surrogate outcome measure in lifestyle-based multidomain prevention trials [29], and the FINGER multi-domain intervention (which included changes to diet, as well as exercise, cognitive training and management of metabolic and vascular risk factors) significantly reduced the CAIDE score [30,31], demonstrating the score has the potential to be responsive to lifestyle factors.…”

Adherence to the Eatwell Guide and cardiometabolic, cognitive and neuroimaging parameters: An analysis from the PREVENT Dementia study

“…There were no significant associations between either the binary or graded EWG scores and the CAIDE score, suggesting EWG adherence is not associated with risk for dementia in this midlife cohort. The CAIDE score was selected as one of the most commonly used dementia risk scores, with associations between the score and neuroimaging outcomes previously reported in the PREVENT dementia cohort [46][47][48][49]. Importantly the CAIDE score reflects the accumulation of cardiovascular risk for dementia, factors which may be the most amenable to dietary interventions.…”

“…The CAIDE score combines a number of nonmodifiable and potentially modifiable risk factors. It was selected as it has previously been associated with a number of neuroimaging outcomes in the PREVENT dementia cohort (43)(44)(45)(46)(47).…”

Application of magnetic resonance imaging-related techniques in the diagnosis of sepsis-associated encephalopathy: present status and prospect

“…Thus, we can consider the possibility of developing brain dysfunction. However, WMH is also a typical manifestation of aging and cerebrovascular diseases ( Dounavi et al, 2022 ), which may be caused by many different pathologies, and is not specific enough to be used alone to diagnose SAE. When diagnosing SAE, combining it with other imaging diagnostic techniques is necessary.…”