Qualitative And Quantitative Analysis Of White Matter Lesions In Cerebral Small Vessel Disease Patients With Cognitive Impairment

Purpose: Using Fazekas scale and tract-based spatial statistics(TBSS)to qualitatively and quantitatively analysis white matter(WM)lesions in cerebral small vessel disease(CSVD)patients with cognitive impairment.Explore the value of multimodal magnetic resonance(MRI)in CSVD induced cognitive impairment.Methods: From January 2018 to December 2019,115 subjects were consecutively enrolled from Suzhou Hospital Affiliated to Nanjing Medical University,including 63 CSVD patients with cognitive impairment(cognitive impairment group)and 52 healthy people(control group).The cognitive status was evaluated by Montreal Cognitive Scale(Mo CA).Fazekas scale and diffusion tensor imaging TBSS analysis were used to evaluate the degree of white matter lesions.Multivariate logistic regression analysis was used to determine the independent risk factors for cognitive impairment.The receiver operating characteristic(ROC)curve was used to identify the recognition ability of different MRI techniques.Results: 1)The scores of overall cognitive status,execution,memory,attention,calculation and language ability were lower in cognitive impairment group(p<0.05).2)The Fazekas score of periventricular WM in cognitive impairment group was higher than control group(p<0.05).There was no significant difference in deep brain WM between the two groups(p(29)0.05).Multivariate logistic regression analysis showed that hyperintensities of periventricular WM and systolic pressure were independent risk factors for cognitive impairment in patients with CSVD.(odds ratio 14.517、1.030;95% CI 2.391～88.134、1.004～1.056;p=0.004、0.024).3)The results of TBSS analysis showed that there were significant difference of diffusion parameters between two groups in the genu of corpus callosum,thalamic anterior radiation,frontal occipital fasciculus and superior longitudinal fasciculus(p<0.05).Partial correlation analysis was carried out with age,gender and years of education as covariates.The FA and MD values of the corpus callosum and RD values of the left inferior frontal occipital fasciculus were significantly correlated with cognitive scores(r=0.201;-0.194;-0.186,p=0.033;0.040;0.048).4)ROC analysis showed that the areas under the curve of the periventricular and deep brain WM Fazekas scores,FA,MD value of the genu of corpus callosum and the RD value of the left inferior frontal occipital fasciculus were 0.59,0.75,0.71,0.75,0.83 respectively.Conclusion: There are extensive white matter lesions of cognitive impairment in CSVD patients.The structural changes of commissural and association fasciculus may play an important role in vascular cognitive impairment.TBSS analysis may be superior to Conventional MRI in the assessment of WM change and recognition of CSVD cognitive impairment.Some diffusion parameters have a certain correlation with overall cognitive status,and may be used as imaging markers for early diagnosis.