CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(04): 356-363
DOI: 10.4103/ijri.IJRI_326_19
Neuroimaging

Evaluation of cerebral microstructural changes in adult patients with obstructive sleep apnea by MR diffusion kurtosis imaging using a whole-brain atlas

Sameer Vyas
Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Paramjeet Singh
Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Niranjan Khandelwal
Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Varan Govind
Department of Radiology, University of Miami, Miami, Florida, USA
,
Ashutosh Aggarwal
Departments of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Mohanty Manju Nath
Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Institutsangaben
Financial support and sponsorship Nil.

Abstract

Purpose: The association between obstructive sleep apnea (OSA) and cognitive impairment is well-recognized, but little is known about neural derangements that underlie this phenomenon. The purpose of this study was to evaluate the utility of diffusion kurtosis imaging (DKI) using a whole-brain atlas to comprehensively assess microstructural tissue changes in the brain of patients with OSA. Methods: This prospective study was conducted in 20 patients with moderate-to-severe OSA and 20 age- and gender-matched controls. MRI data acquisition was performed with 3 Tesla and data was analyzed using a whole-brain atlas. DKI data were processed and transformed into a brain template space to obtain various kurtosis parameters including axial kurtosis (AK), radial kurtosis (RK), mean kurtosis (MK), and kurtosis fractional anisotropy (KFA) using a 189-region brain atlas in the same template space. These kurtosis measurements were further analyzed using a student t-test in order to determine kurtosis measurements that present significant differences between the OSA patient set and the control set. Results: Significant differences (P < 0.05) were found in AK (54 regions), RK (10 regions), MK (6 regions) and KFA (41 regions) values in patients with OSA as compared to controls. DKI indices, using an atlas-based whole-brain analysis approach used in our study, showed widespread involvement of the anatomical regions in patients with OSA. Conclusion: The kurtosis parameters are more sensitive in demonstrating abnormalities in brain tissue structural organization at the microstructural level before any detectable changes appear in conventional MRI or other imaging modalities.



Publikationsverlauf

Eingereicht: 07. August 2019

Angenommen: 23. Oktober 2019

Artikel online veröffentlicht:
21. Juli 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Zimmerman ME, Aloia MS. A review of neuroimaging in obstructive sleep apnea. J Clin Sleep Med 2006; 2: 461-71
  • 2 Macey PM, Henderson LA, Macey KE, Alger JR, Frysinger RC, Woo MA. et al. Brain morphology associated with obstructive sleep apnea. Am J Resp Crit Care 2002; 166: 1382-7
  • 3 Morrell MJ, Jackson ML, Twigg GL, Ghiassi R, McRobbie DW, Quest RA. et al. Changes in brain morphology in patients with obstructive sleep apnoea. Thora× 2010; 65: 908-14
  • 4 O’Donoghue FJ, Briellmann RS, Rochford PD, Abbott DF, Pell GS, Chan CH. et al. Cerebral structural changes in severe obstructive sleep apnea. Am J Respir Crit Care Med 2005; 171: 1185-90
  • 5 Morrell MJ, McRobbie DW, Quest RA, Cummin AR, Ghiassi R, Corfield DR. Changes in brain morphology associated with obstructive sleep apnea. Sleep Med 2003; 4: 451-4
  • 6 Kumar R, Pham TT, Macey PM, Woo MA, Yan-Go FL, Harper RM. Abnormal myelin and axonal integrity in recently diagnosed patients with obstructive sleep apnea. Sleep 2014; 37: 723-32
  • 7 Kumar R, Chavez AS, Macey PM, Woo MA, Yan-Go FL, Harper RM. Altered global and regional brain mean diffusivity in patients with obstructive sleep apnea. J Neurosci Res 2012; 90: 2043-52
  • 8 O’Donoghue FJ, Wellard RM, Rochford PD, Dawson A, Barnes M, Ruehland WR. et al. Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment. Sleep 2012; 35: 41-8
  • 9 Steven AJ, Zhuo J, Melhem ER. Diffusion kurtosis imaging: An emerging technique for evaluating the microstructural environment of the brain. AJR Am J Roentgenol 2014; 202: W26-33
  • 10 Fieremans E, Jensen JH, Helpern JA. White matter characterization with diffusional kurtosis imaging. Neuroimage 2011; 58: 177-88
  • 11 Macey PM, Kumar R, Woo MA, Valladares EM, Yan-Go FL, Harper RM. Brain structural changes in obstructive sleep apnea. Sleep 2008; 31: 967-77
  • 12 Chen HL, Lu CH, Lin HC, Chen PC, Chou KH, Lin WM. et al. White matter damage and systemic inflammation in obstructive sleep apnea. Sleep 2015; 38: 361-70
  • 13 Emin Akkoyunlu M, Kart L, Kılıçarslan R, Bayram M, Aralasmak A, Sharifov R. et al. Brain diffusion changes in obstructive sleep apnoea syndrome. Respiration 2013; 86: 414-20
  • 14 Castronovo V, Scifo P, Castellano A, Aloia MS, Iadanza A, Marelli S. et al. White matter integrity in obstructive sleep apnea before and after treatment. Sleep 2014; 37: 1465-75
  • 15 Harper RM, Kumar R, Ogren JA, Macey PM. Sleep-disordered breathing: Effects on brain structure and function. Respir Physiol Neurobiol 2013; 188: 383-91
  • 16 Tummala S, Roy B, Park B, Kang DW, Woo MA, Harper RM. et al. Associations between brain white matter integrity and disease severity in obstructive sleep apnea. J Neurosci Res 2016; 94: 915-23
  • 17 Tummala S, Roy B, Vig R, Park B, Kang DW, Woo MA. et al. Non-gaussian diffusion imaging shows brain myelin and axonal changes in obstructive sleep apnea. J Comput Assist Tomogr 2017; 41: 181-9
  • 18 Tummala S, Palomares J, Kang DW, Park B, Woo MA, Harper RM. et al. Global and regional brain non-gaussian diffusion changes in newly diagnosed patients with obstructive sleep apnea. Sleep 2016; 39: 51-7
  • 19 Tabesh A, Jensen JH, Ardekani BA, Helpern JA. Estimation of tensors and tensor-derived measures in diffusional kurtosis imaging. Mag Reson Med 2011; 65: 823-36
  • 20 Ceritoglu C, Oishi K, Li X, Chou MC, Younes L, Albert M. et al. Multi-contrast large deformation diffeomorphic metric mapping for diffusion tensor imaging. Neuroimage 2009; 47: 618-27
  • 21 ROI Editor. Available from: https://www.mristudio.org. [last accessed on 2019 Dec 28]