Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes

Abstract

Background and Purpose: Diabetic retinopathy (DR) is one of the common microvascular complications in diabetes. The total magnetic resonance imaging (MRI) burden of cerebral small vessel disease (CSVD) tends to be increased in diabetic patients and is a marker of microvascular disease; however, the relationship between DR and CSVD is unclear. This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes.Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University. All patients underwent retinal photography and cerebral MRI. The central retinal artery equivalent (CRAE), the central retinal venous equivalent (CRVE), and arteriole-to-venule ratio (AVR) were calculated using Image J software to determine the retinal vascular calibers for each patient. The total MRI burden score for CSVD was determined, and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed.Results: Of the 151 diabetic patients included in the study, 84 (55.6%) had no diabetic retinopathy (NDR), 27 (17.9%) had mild DR, and 40 (26.5%) had moderate, or severe non-proliferative DR (grouped together for this study as “more than mild DR”). In patients with more than mild DR, the proportion of moderate to severe burden of CSVD was 75%, which was higher than in patients with mild DR (48.1%) or NDR (26.2%). Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles (105.24 ± 8.42 μm vs. 109.45 ± 7.93 μm), widened retinal venules (201.67 ± 16.25 μm vs. 193.95 ± 13.54 μm), and lower arteriole-to-venule ratio (0.52 ± 0.05 vs. 0.57 ± 0.04) (P < 0.05 for all). The degree of DR (r = 0.465, P < 0.001) and CRVE (r = 0.366, P < 0.001) were positively correlated with the total MRI burden of CSVD. Multivariate logistic regression analysis indicated that, after adjustments were made for age, smoking, alcohol consumption, hypertension, and other factors, more than mild DR (OR, 4.383; P = 0.028), CRAE (OR, 0.490; P = 0.031), and CRVE (OR, 1.475; P = 0.041) were independently associated with moderate to severe burden of CSVD.Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions. The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.

Decreased Local Specialization of Brain Structural Networks Associated with Cognitive Dysfuntion Revealed by Probabilistic Diffusion Tractography for Different Cerebral Small Vessel Disease Burdens

“…In this study, CSVD patients were further grouped into those with a mild CSVD burden (CSVD-m; burden score 0–1; 133; age: 62.11 ± 6.88 years) and those with a severe CSVD burden (CSVD-s, burden score 2–4; 67; age: 64.16 ± 5.48 years). This stratification was consistent with the previous studies [ 9 , 10 ].…”

“…The results showed that motor dysfunction, cognitive impairment, depression, and anxiety were significantly worse in patients with severe CSVD than in those with mild CSVD [ 9 ]. A study on type 2 diabetes, divided patients into mild burden (0–1 points) group and moderate to severe burden (2–4 points) group based on the total CSVD burden score, demonstrated that the moderate to severe burden group was more likely than the mild burden group to have narrowed retinal arterioles, widened retinal venules, and lower arteriole-to-venule ratio [ 10 ]. These findings suggested that the CSVD burden affected the basic structure of gray and white matter in the brain, as well as the development and clinical manifestations of various diseases.…”

Impact of total cerebral small vessel disease score on ophthalmic artery morphologies and hemodynamics

“…However, the correlation between retinal arteriolar caliber and CSVD is considered controversial [17][18][19]. Retinal arteries are usually susceptible to hypertension, diabetes, and other factors [20,21]. By contrast, OA can reflect changes in ocular blood flow in patients with CSVD early, directly, and accurately.…”

Retinal structure and vessel density changes in cerebral small vessel disease

“…The blood-retinal barrier is structurally and functionally similar to the blood–brain barrier as well. Previous studies have demonstrated the close relationship between retinal microvascular abnormality and stroke ( Hughes et al, 2016 ; Umemura et al, 2017 ; Zhang et al, 2021 ). As a result, retinal vascular changes can reflect intracranial small vessel changes to some extent.…”