Increased iron deposition of deep cerebral gray matter structures in hemodialysis patients: A longitudinal study using quantitative susceptibility mapping

Abstract

Background The cerebral iron overload in hemodialysis patients has been reported in a previous study, in which the evaluation of the changes in iron content could be affected by the cross‐sectional analysis. Purpose To investigate the longitudinal changes of iron deposition in hemodialysis patients using quantitative susceptibility mapping (QSM) and correlate these findings with the longitudinal changes of neurocognitive function and clinical factors. Study Type Prospective; longitudinal. Population In all, 34 patients and 30 healthy controls (HCs); the mean follow‐up interval was 22 ± 7 months. Field Strength/Sequence 3.0T, susceptibility‐weighted imaging (SWI). Assessment QSM reconstructed from original phase data of SWI was used to measure the susceptibility of gray matter structures including bilateral caudate nucleus (CN), globus pallidus (GP), putmen (PUT), red nucleus (RN), substantia nigra (SN), dentate nucleus (DN), thalamus (THA), pulvinar of thalamus (PT). The Mini‐Mental State Examination (MMSE) test and clinical factors were recorded. Statistical Testing Analysis of covariance adjusting for age and gender as covariates or a paired t‐test for the differences in susceptibility, MMSE scores, and clinical factors among baseline, follow‐up patients, and HCs. Correlation and stepwise regression analysis for the relationship between susceptibility, MMSE scores, and clinical factors. Results The susceptibility of bilateral CN, GP, PUT, RN, SN, DN, THA, PT in follow‐up patients was significantly higher than that in baseline between patients and HCs except for left THA (all P < 0.05; Bonferroni corrected). MMSE scores significantly negatively correlated with the susceptibility of bilateral CN, PUT, and RRN in the baseline examination and bilateral CN, PUT, RN, and DN in the follow‐up examination (all P < 0.05; false discovery rate [FDR] corrected). The follow‐up interval, creatinine, phosphorus, and calcium were independent factors for the increased susceptibility of some nuclei (all P < 0.05). Data Conclusion The iron deposition of gray matter nuclei in hemodialysis patients increased over roughly a 2‐year period and may be a risk factor for neurocognitive impairment. Creatinine and abnormal calcium‐phosphorus metabolism were independent risk factors for abnormal iron deposition. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:786–799.

Iron Deposition Characteristics of Deep Gray Matter in Elderly Individuals in the Community Revealed by Quantitative Susceptibility Mapping and Multiple Factor Analysis

“…Previous MRI studies that focused on differences in brain iron levels between sexes and hemispheric locations reported different results (Xu et al, 2008;Gong et al, 2015;Persson et al, 2015;Chai et al, 2019;Peterson et al, 2019). However, our data showed no sex-or hemisphere-related differences in iron levels in any of the regions studied.…”

Increased Brain Iron Detection by Voxel-Based Quantitative Susceptibility Mapping in Type 2 Diabetes Mellitus Patients With an Executive Function Decline

“…Because it is easy to provide precise location information of the brain regions for voxel-based morphometry (VBM) ( Chen et al, 2017 ), VBM has been used widely, and gray matter structural and volume alterations of the brain have been revealed to be related to cognitive impairment ( Liu et al, 2017 ). On the basis of a growing number of studies on MRI, brain iron overload has been observed in various neurodegenerative illnesses and is related to cognitive decline ( Ward et al, 2014 ; Del et al, 2015 ; Daglas and Adlard, 2018 ; Chai et al, 2019 ). Quantitative susceptibility mapping (QSM) represents an updated MRI strategy that facilitates quantification of materials by changing susceptibility and enables non-invasive quantitative analysis of brain iron deposition ( de Rochefort et al, 2010 ; Schweser et al, 2012 ; Wang et al, 2017 ).…”

Regional Cerebral Gray Matter Atrophy Is Associated With Cognitive Impairment in Hemodialysis Patients: a Cross-sectional and Longitudinal Voxel-based Morphological Mri Study

“…Increased serum urea, parathyroid hormone levels, and hemodialysis duration were independent risk factors for decreased GMV in hemodialysis patients (all P<0.05, FDR corrected). Hemodialysis patients had lower MMSE (27[26,29]) and MoCA (22[19.48,24.04]) scores than HCs (30[29, 30] and 28[26.89,29]) (all P<0.05). The MMSE scores of hemodialysis patients at follow-up (26[25, 28.5]) were lower than those of patients at baseline (28[25, 29.5]) (P=0.02).…”