The Application Research Of MRS Combined With DKI In The Bilateral Hippocampus And Posterior Cingulate Gyrus Of Type 2 Diabetes

Objective: In this study we used new magnetic resonance sequences MRS and DKI to explore the damage of hippocampus and posterior cingulate gyrus in patients with T2 DM,and the comprehensive application value of multiple sequences of magnetic resonance imaging in hippocampus and posterior cingulate gyrus injury in T2 DM,providing imaging evaluation basis for early damage of both hippocampus and posterior cingulate of T2 DM.We collected clinical data(HbA1c,fasting blood glucose,diabetes duration,etc.)of patients with T2 DM,and try to analyze the correlation between microstructural damage and metabolic abnormalities of T2 DM patients with mild cognitive impairment.Materials and Methods: According to the inclusion criteria,42 inpatients with T2 DM admitted to the Department of Endocrinology at the First Hospital of Lanzhou University from March 2017 to January 2018 were selected,and the patients were classified as A according to the Montreal Cognitive Assessment Scale(MoCA).In group B,group A had mild cognitive impairment in patients with T2DM(MoCA score <26),including 6 males and 9 females,and group B had T2 DM patients without cognitive impairment(MoCA score)≥26 points),including 11 males and 16 females.In the same period,20 non-type 2 diabetes patients were collected as control group C,including 10 males and 10 females.Siemens 3.0T MRI T1 WI,T2WI,DWI,MRS,DKI and other sequence scans were performed in all patients.Simultaneous MoCA Simplified Scoring was performed.The DKI and MRS images are taken from the same region of the same anatomical level in the bilateral hippocampus and posterior cingulate.The same ROI is taken for symmetrical measurement.After computer software postprocessing,DKI obtains MK value,MD value,and FA value.MRS obtains N.-Acetyl aspartate(NAA),Choline complex(Cho),Creatine(mI),Inositol(Cr),and record all clinically relevant data.Spss23.0 statistical software was used to analyze the collected and measured data,P<0.05 difference was statistically significant.Results:1.Comparison of the general conditions of patients in groups A,B and CThere was no significant difference in gender composition,age,and years of education among the three groups(P>0.05).There was no history of diabetes in group C.The duration of diabetes in group A was significantly longer than that in group B(P<0.05);body mass index(BMI)in group A and B.Significantly greater than in group C(P<0.05).There was no significant difference in BMI between group A and group B(P>0.05).The MoCA score in group A was significantly lower than that in group B and C(P<0.05).There was no difference between group B and group C.Significant differences(P>0.05).2.Comparison of laboratory testsThe HbA1 c values in the three groups were significantly different(P<0.05).The fasting plasma glucose(FPG)values in the A and B groups were significantly higher than those in the C group(P<0.05).There was no significant difference between the A and B groups(P>0.05).There was no significant difference in total cholesterol(TC)values between the three groups A,B and C(P>0.05).3.Comparison of DKI valuesIn group A,B and C,only the left and right hippocampal A and B groups had lower MK and higher MD values than those in group C.The A group had lower FA values than the C group;the right hippocampal A group had more MD values than the C group.In group A,the MK and FA were lower than those in group B and C.In the left posterior cingulate group,the MK values in group A and B were lower than those in group C.The MD values in group A were higher than those in group B and C,and those in groups A and B were higher than those in group C.The value decreased;the right posterior cingulum to the A,B group than the C group of patients with MD increased,A group than the C group MK values,FA values decreased,with statistical significance(P <0.05).4.Comparison of MRS valuesMRS values were compared between the three groups: NAA,Cho,mI,and Glx values in the left hippocampus;NAA,Cho,and mI values in the right hippocampal region;Glx differences in the A,B,A,and C groups.Significance(P<0.05);Differences in NAA/Cr,Cho/Cr,mI/Cr,and Glx/Cr between the three groups of the hippocampus were compared between the MRS ratio groups,NAA/Cr differences between groups A and B on the left posterior cingulate,and B and C.Differences in Cho/Cr,mI/Cr,and Glx/Cr between groups,differences in NAA/Cr,Cho/Cr,mI/Cr,and Glx/Cr between groups A and C,and NAA/Cr in groups A and B on the right side of the cingulate Differences between groups B/C Cho/Cr,mI/Cr,and Glx/Cr were significant.Differences between groups A,C,NAA/Cr,Cho/Cr,mI/Cr,and Glx/Cr were statistically significant(P<0.05).5.Correlation analysis of diabetes mellitus course,MoCA score,HbA1 c,BMI,TC and other related risk factors and microstructure damage and metabolic abnormalities in bilateral hippocampus and posterior cingulate gyrus in patients with T2 DM with mild cognitive impairmentThe MoCA score was negatively correlated with the hippocampal mI value,the hippocampal mI/Cr value,and the duration of diabetes,and was correlated with the bilateral posterior cingulate NAA,the left posterior cingulate FA,and the right posterior cingulate MK.Correlation;Diabetes duration was negatively correlated with the left hippocampal NAA/Cr value;HbA1c value was positively correlated with the right hippocampal mI value;FPG and left hippocampal Cho value,left posterior cingulate back mI value,right hippocampal MD value Negative correlation;BMI was positively correlated with Glx/Cr value in the left posterior cingulate,negatively correlated with MD value in the right hippocampus;TC was positively correlated with Glx value in the left hippocampus and MK value in the right posterior cingulate,P< 0.05 is statistically significant.In conclusions:1.As a MR diffusion imaging technique,DKI can change the value of MK,MD and FA,which can reflect the damage of T2 DM bilateral hippocampus and posterior cingulate microstructure.2.The area under the curve of MRS and the ratio of each value of NAA,Cho,mI,Glx,NAA/Cr,Cho/Cr,mI/Cr,and Glx/Cr decreased or increased,indicating that MRS can be metabolized from the molecular microscopic The level reflects the damage of T2 DM bilateral hippocampus and posterior cingulate gyrus.3.DKI shows changes in the microstructural changes in the bilateral hippocampus and posterior cingulate gyrus in patients with T2 DM.The MRS confirms and supplements the lesions in the bilateral hippocampus and posterior cingulate gyrus in patients with T2 DM from the molecular metabolic changes.MRS Combined DKI can more accurately reflect the injury of T2 DM bilateral hippocampus and posterior cingulate gyrus.The two complement each other and complement each other.The results of MRS and DKI measurements in patients with T2 DM were related to the duration of diabetes,HbA1 c,and MoCA scores,indicating that the duration of diabetes,HbA1 c,BMI,etc.had a certain impact on bilateral hippocampal and posterior cingulate ictal injury in T2 DM patients.The control of HbA1 c,FPG and BMI in the treatment of clinical T2 DM patients is of great significance to the prognosis of T2 DM patients.