Preliminary Study Of 3D-ASL Technique To Assess Altered Cerebral Perfusion In Patients With Type 2 Diabetes Mellitus Combined With Hypertension

Objective: Using 3D-ASL technology to detect changes in cerebral blood flow(CBF)in patients with type 2 diabetes mellitus(T2DM)and hypertension,exploring the correlation between CBF changes and various clinical variables and cognitive performance.Methods:35 patients with clinically confirmed normal blood pressure with type 2diabetes mellitus(T2DM),27 patients with type 2 diabetes mellitus combined with hypertension(T2DMH)and 28 healthy controls(HC)were selected.All subjects were scanned with conventional sequences of cranial MRI(T1WI,T2 WI,T2-FLAIR)to exclude organic diseases such as cerebrovascular disease and tumours,and those enrolled also underwent scientific sequences(3D-T1 WI,3D-ASL).The ASL data were post-processed with Cere Flow software to obtain CBF values for 90 brain regions within the automatic anatomical template(AAL)based atlas.Age,gender and education were used as covariates to conduct an analysis of covariance on CBF between the T2 DM and HC groups and between the T2 DM and T2 DMH groups to investigate the correlation between changes in CBF and a variety of clinical variables and cognitive performance.Results: In a comparative analysis with the HC group,CBF was increased in the frontal lobe(left triangular inferior frontal gyrus,left intraorbital gyrus)and decreased in the temporal lobe(left middle temporal gyrus),parietal lobe(left precuneus),occipital lobe(right syrinx),and limbic system(right hippocampus and left thalamus)in the T2 DMH group;compared with the T2 DM group,CBF was increased in the frontal lobe(right triangular inferior frontal gyrus),temporal lobe(right superior temporal gyrus),and The CBF of the frontal lobe(right inferior frontal gyrus),temporal lobe(right superior temporal gyrus),parietal lobe(left precuneus,left postcentral gyrus,left superior parietal lobule),and basal ganglia(left nucleus accumbens,left pallidum)were reduced in the T2 DMH group compared with the T2 DMH group,suggesting that the presence of hypertension aggravated the damage in these brain regions;the CBF values of the right superior temporal gyrus,left superior parietal lobule,and left nucleus accumbens were negatively correlated with HOMA-IR in the T2 DMH group(r=-0.352,-0.465,-0.425,p =0.048,0.007,0.015);CBF of the left middle temporal gyrus,left precuneus,and right hippocampus were negatively correlated with BMI in the T2 DM group(r=-0.553,-0.354,-0.360,p=0.001,0.047,0.043).Conclusions: Our findings provide an important imaging basis for the underlying neurological mechanisms of brain injury in patients with T2 DM combined with hypertension.Hypertension exacerbates abnormal changes in cerebral perfusion in patients with T2 DM,mainly affecting somatosensory,visual and auditory areas;hypertension may exacerbate brain injury in patients with T2 DM by increasing the level of insulin resistance;and in patients with T2 DM,in addition to blood pressure and blood glucose control,reasonable weight control has positive significance for improving cerebral perfusion.