Altered resting cerebral blood flow specific to patients with diabetic retinopathy revealed by arterial spin labeling perfusion magnetic resonance imaging

Abstract

Background Previous neuroimaging studies have shown that patients with diabetic retinopathy (DR) were accompanied by abnormalities in cerebral functional and structural architecture, whereas the resting cerebral blood flow (CBF) alterations in patients with DR are not well understood. Purpose To explore CBF alterations in patients with DR using pseudo-continuous arterial spin labeling (pCASL) imaging. Material and Methods Thirty-one individuals with DR (15 men, 16 women; mean age = 53.38 ± 9.12 years) and 33 healthy controls (HC) (12 men, 21 women; mean age = 51.61 ± 9.84 years) closely matched for age, sex, and education, underwent pCASL imaging scans. Two-sample T test was conducted to compare different CBF values between two groups. Results Patients with DR exhibited significantly increased CBF values in the left middle temporal gyrus (Brodmann’s area, BA 22) and the bilateral supplementary motor area (BA3) and decreased CBF values in the bilateral calcarine (BA17,18) and bilateral caudate relative to HC group (two-tailed, voxel level at P < 0.01, Gaussian random field (GRF), cluster level at P < 0.05). Moreover, the HbA1c (%) level showed a positive correlation with CBF values in the bilateral caudate (r = 0.473, P = 0.007) in patients with DR. Conclusion Our results highlighted that patients with DR had abnormal CBF values in the visual cortices, caudate, middle temporal gyrus, and supplementary motor area, which might reflect vision and sensorimotor and cognition dysfunction in patients with DR. These findings might help us to understanding the neural mechanism of patients with DR.

Cerebral Blood Flow Alterations in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Arterial Spin Labeling Studies

“…A total of 369 records were identified through database searching and citation searching, and Figure 1 shows the flowchart of literature search and study selection. We finally included 13 studies with 14 reports in the systematic review ( Last et al, 2007 ; Jor’dan et al, 2014 ; Novak et al, 2014 ; Rusinek et al, 2015 ; Xia et al, 2015 ; Jansen et al, 2016 ; Cui et al, 2017 ; Dai et al, 2017 ; Shen et al, 2017 ; Bangen et al, 2018 ; Zhang et al, 2019 ; Chau et al, 2020 ; Huang et al, 2021 ). One study performed analysis using both ROI and VBA methods ( Jansen et al, 2016 ).…”

“…One study performed analysis using both ROI and VBA methods ( Jansen et al, 2016 ). As 1 of 8 VBA reports had no available coordinate ( Novak et al, 2014 ), 7 studies with 7 reports were finally included in the meta-analysis ( Xia et al, 2015 ; Jansen et al, 2016 ; Cui et al, 2017 ; Dai et al, 2017 ; Shen et al, 2017 ; Zhang et al, 2019 ; Huang et al, 2021 ).…”

“…A recent meta-analysis study of functional magnetic resonance imaging (fMRI) also revealed consistent hypoactivity in the middle occipital gyrus and calcarine fissure/surrounding cortex in T2DM ( Yao et al, 2021 ). Beside, recent studies focusing on patients with diabetic retinopathy observed decreased CBF in the bilateral calcarine fissure/surrounding cortex ( Huang et al, 2021 ) and hypoactivity in the middle occipital gyrus ( Wang et al, 2017 ; Qi et al, 2020 ). These findings indicated that the perfusion and function alterations in occipital lobe, which involving vasculopathy and neuropathy along the visual pathway ( Heravian et al, 2012 ), might be attribute to the potential visual impairment, a common comorbidity of diabetes.…”

Aberrant Neurovascular Coupling in Diabetic Retinopathy Using Arterial Spin Labeling (ASL) and Functional Magnetic Resonance Imaging (fMRI) methods

“…This elevation observed in diabetic retinopathy (DR) patients aligns with findings from previous studies. 15 …”

“… 14 We also conducted this study on patients with DR, which revealed significantly higher CBF values in the left middle temporal gyrus and bilateral supplementary motor areas, as well as significantly lower CBF values in the bilateral calyces and bilateral caudate nuclei. 15 …”