Share：
Share this content in WeChat
X
[Chinese][PDF]261
• Clinical Article •
A study investigating the correlation between white matter hyperintensities lesion characteristics in end-stage renal disease patients and clinical indicators using MRI 3D-FLAIR
ZOU Fan  WANG Haibao  FANG Jie  QI Xiangming  ZHOU Yu  LI Xiaoshu 

Cite this article as: ZOU F, WANG H B, FANG J, et al. A study investigating the correlation between white matter hyperintensities lesion characteristics in end-stage renal disease patients and clinical indicators using MRI 3D-FLAIR[J]. Chin J Magn Reson Imaging, 2025, 16(6): 55-59, 65. DOI:10.12015/issn.1674-8034.2025.06.008.


[Abstract] Objective To investigate the volume and distribution characteristics of white matter hyperintensities (WMH) in patients with end-stage renal disease (ESRD) using MRI three dimensional-fluid attenuated inversion recovery (3D-FLAIR), and to determine if specific brain regions are more susceptible to lesion development and to assess the relationship between WMH volume and clinical biochemical markers and cognitive function.Materials and Methods MRI image data and clinical biochemical indices from 81 ESRD patients and 77 healthy controls were collected. CAT12 software was used to analyze 3D-T1WI images to obtain the whole brain volume of each subject. The 3D-FLAIR images were analyzed by Lesion Prediction Algorithm (LPA) in Lesion Segmentation Tool (LST) to obtain the volume and distribution map of WMH. Two-sample t-test and Mann-Whitney U test were used to analyze the differences in cognitive function scores and the severity of WMH (the ratio of WMH to total brain volume) between the two groups. The Liebermeister test in non-parametric mapping (NPM) software was employed to compare the distribution maps between the two groups. After controlling for the effects of age and gender using partial correlation analysis, the correlations between the severity of WMH and both clinical biochemical indicators as well as cognitive function were assessed. Furthermore, the two groups were categorized according to the severity of WMH, and the ROC curve was constructed.Results The cognitive function scores of the ESRD group were significantly lower compared to the control group [Montreal Cognitive Assessment (MoCA): 22.44 ± 5.23 vs. 26.06 ± 3.20, P < 0.001; Mini-Mental State Examination (MMSE): 25.96 ± 3.81 vs. 28.61 ± 1.85, P < 0.001]. The severity of WMH in the ESRD group was significantly higher than in the control group [1.40 (2.60) vs. 0.36 (0.40), P < 0.001]. The proportion of WMH in the ESRD group was also higher (Z: 1.914 to 6.483, P < 0.05). Although WMH severity was not associated with cognitive function (P > 0.05), it was negatively correlated with serum albumin and glomerular filtration rate (r = -0.337, P = 0.002; r = -0.231, P = 0.041). The area under the ROC curve was 0.817 (95% CI: 0.751 to 0.884).Conclusions Periventricular white matter is particularly vulnerable to damage in ESRD patients, which is closely linked to the decline in renal function and serum albumin levels. WMH serves as a significant imaging marker for effectively distinguishing white matter damage in ESRD.
[Keywords] end-stage renal disease；white matter hyperintensities；magnetic resonance imaging

ZOU Fan1   WANG Haibao1   FANG Jie1   QI Xiangming2   ZHOU Yu1   LI Xiaoshu1*  

1 Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

2 Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

Corresponding author: LI X S, E-mail: lixiaoshu2016@163.com

Conflicts of interest   None.

Received  2025-03-18
Accepted  2025-06-05
DOI: 10.12015/issn.1674-8034.2025.06.008
Cite this article as: ZOU F, WANG H B, FANG J, et al. A study investigating the correlation between white matter hyperintensities lesion characteristics in end-stage renal disease patients and clinical indicators using MRI 3D-FLAIR[J]. Chin J Magn Reson Imaging, 2025, 16(6): 55-59, 65. DOI:10.12015/issn.1674-8034.2025.06.008.

[1]
FLYTHE J E, WATNICK S. Dialysis for chronic kidney failure: a review[J]. JAMA, 2024, 332(18): 1559-1573. DOI: 10.1001/jama.2024.16338.
[2]
DECARLI C, RAJAN K B, JIN L W, et al. WMH contributions to cognitive impairment: rationale and design of the diverse VCID study[J]. Stroke, 2025, 56(3): 758-776. DOI: 10.1161/STROKEAHA.124.045903.
[3]
MAILLARD P, FLETCHER E, CARMICHAEL O, et al. Cerebrovascular markers of WMH and infarcts in ADNI: a historical perspective and future directions[J]. Alzheimers Dement, 2024, 20(12): 8953-8968. DOI: 10.1002/alz.14358.
[4]
WU X Q, YA J Y, ZHOU D, et al. Pathogeneses and imaging features of cerebral white matter lesions of vascular origins[J]. Aging Dis, 2021, 12(8): 2031-2051. DOI: 10.14336/AD.2021.0414.
[5]
JIANG Y H, DU W, LI Y, et al. Disturbed dynamic brain activity and neurovascular coupling in end-stage renal disease assessed with MRI[J]. J Magn Reson Imaging, 2025, 61(4): 1831-1844. DOI: 10.1002/jmri.29597.
[6]
ZHENG K, ZHOU Y Z, QIAN Y J, et al. Increased premature cerebral small vessel diseases in dialysis patients: a retrospective cross-sectional study[J]. Nephron, 2021, 145(4): 330-341. DOI: 10.1159/000513121.
[7]
FISHER M. Mechanisms of cerebral microvascular disease in chronic kidney disease[J/OL]. J Stroke Cerebrovasc Dis, 2021, 30(9): 105404 [2024-04-22]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8164637. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105404.
[8]
GRECO F, QUARTA L G, PARIZEL P M, et al. Relationship between chronic kidney disease and cerebral white matter hyperintensities: a systematic review[J]. Quant Imaging Med Surg, 2023, 13(11): 7596-7606. DOI: 10.21037/qims-22-707.
[9]
KUMMARI S, BURRA K G, REDDY V R K, et al. Determination of efficiency of 3D fluid-attenuated inversion recovery (FLAIR) in the imaging of multiple sclerosis in comparison with 2D FLAIR at 3-tesla MRI[J/OL]. Cureus, 2023, 15(11): e48136 [2024-04-22]. https://pmc.ncbi.nlm.nih.gov/articles/PMC10693390. DOI: 10.7759/cureus.48136.
[10]
SCHMIDT P, GASER C, ARSIC M, et al. An automated tool for detection of FLAIR-hyperintense white-matter lesions in Multiple Sclerosis[J]. Neuroimage, 2012, 59(4): 3774-3783. DOI: 10.1016/j.neuroimage.2011.11.032.
[11]
RIBALDI F, ALTOMARE D, JOVICICH J, et al. Accuracy and reproducibility of automated white matter hyperintensities segmentation with lesion segmentation tool: a European multi-site 3T study[J]. Magn Reson Imaging, 2021, 76: 108-115. DOI: 10.1016/j.mri.2020.11.008.
[12]
STRINGER M S, BLAIR G W, KOPCZAK A, et al. Cerebrovascular function in sporadic and genetic cerebral small vessel disease[J]. Ann Neurol, 2025, 97(3): 483-498. DOI: 10.1002/ana.27136.
[13]
PHUAH C L, CHEN Y, STRAIN J F, et al. Association of data-driven white matter hyperintensity spatial signatures with distinct cerebral small vessel disease etiologies[J/OL]. Neurology, 2022, 99(23): e2535-e2547 [2024-04-22]. https://pmc.ncbi.nlm.nih.gov/articles/PMC9754646. DOI: 10.1212/wnl.0000000000201186.
[14]
CHEN H J, QIU J, XU X L, et al. Abnormal white matter along fibers by automated fiber quantification in patients undergoing hemodialysis[J]. Neurol Sci, 2023, 44(12): 4499-4509. DOI: 10.1007/s10072-023-06912-8.
[15]
CAO X S, SUI B, WU B L, et al. MR study on white matter injury in patients with acute diquat poisoning[J]. Neurotoxicology, 2025, 106: 37-45. DOI: 10.1016/j.neuro.2024.12.002.
[16]
AMAN A, HOSKOTE A, JADHAV K S, et al. Comparative analysis of brain volumetric measurements between contrast-enhanced and non-contrast MRI images[J/OL]. Neurosci Lett, 2025, 848: 138118 [2025-02-01]. https://www.sciencedirect.com/science/article/pii/S0304394025000060via%3Dihub. DOI: 10.1016/j.neulet.2025.138118.
[17]
CARTON C, CALAFIORE M, CAUET C, et al. Montreal Cognitive Assessment (MoCA) use in general practice for the early detection of cognitive impairment: a feasibility study[J/OL]. BJGP Open, 2025, 9(1): BJGPO.2024.0039 [2025-02-01]. https://bjgpopen.org/content/9/1/BJGPO.2024.0039.long. DOI: 10.3399/BJGPO.2024.0039.
[18]
SEJUNAITE K, BELAL Y, LANZA C, et al. Different meanings of a three-point decline in MMSE score in Alzheimer's disease and depressive disorder[J/OL]. BJPsych Open, 2024, 10(5): e145 [2025-02-01]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11698181. DOI: 10.1192/bjo.2024.732.
[19]
VEMURI P, DAVEY C, JOHANSEN K L, et al. Chronic kidney disease associated with worsening white matter disease and ventricular enlargement[J]. J Alzheimers Dis, 2021, 83(4): 1729-1740. DOI: 10.3233/JAD-210604.
[20]
PLANTONE D, VOLLONO C, PARDINI M, et al. A voxel-based lesion symptom mapping analysis of chronic pain in multiple sclerosis[J]. Neurol Sci, 2021, 42(5): 1941-1947. DOI: 10.1007/s10072-020-04745-3.
[21]
MOON H I, JEONG Y J, SUH J H. Voxel-based lesion symptom mapping analysis for dysphagia in stroke patients with isolated cerebellar lesions[J]. J Neural Transm (Vienna), 2022, 129(1): 65-74. DOI: 10.1007/s00702-021-02438-5.
[22]
YUSIPOV I, KONDAKOVA E, KALYAKULINA A, et al. Accelerated epigenetic aging and inflammatory/immunological profile (ipAGE) in patients with chronic kidney disease[J]. Geroscience, 2022, 44(2): 817-834. DOI: 10.1007/s11357-022-00540-4.
[23]
BACHMANN D, VON RICKENBACH B, BUCHMANN A, et al. White matter hyperintensity patterns: associations with comorbidities, amyloid, and cognition[J/OL]. Alzheimers Res Ther, 2024, 16(1): 67 [2025-02-01]. https://pmc.ncbi.nlm.nih.gov/articles/PMC10983708. DOI: 10.1186/s13195-024-01435-6.
[24]
WU L, ZHENG G, ZHANG L J, et al. Brain blood perfusion changes in patients with end-stage renal disease: a MRI study using pseudo continuous arterial spin labeling(pCASL) technique and the correlation of these changes with cognitive dysfunction[J]. Radiol Pract, 2017, 32(8): 808-811. DOI: 10.13609/j.cnki.1000-0313.2017.08.005.
[25]
VIGGIANO D, WAGNER C A, MARTINO G, et al. Mechanisms of cognitive dysfunction in CKD[J]. Nat Rev Nephrol, 2020, 16(8): 452-469. DOI: 10.1038/s41581-020-0266-9.
[26]
ZHANG Y, SONG Z H, WU R, et al. PRRC2B modulates oligodendrocyte progenitor cell development and myelination by stabilizing Sox2 mRNA[J/OL]. Cell Rep, 2024, 43(3): 113930 [2025-02-01]. https://www.cell.com/cell-reports/fulltext/S2211-1247(24)00258-4_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2211124724002584%3Fshowall%3Dtrue. DOI: 10.1016/j.celrep.2024.113930.
[27]
LI H, JACOB M A, CAI M F, et al. Regional cortical thinning, demyelination and iron loss in cerebral small vessel disease[J]. Brain, 2023, 146(11): 4659-4673. DOI: 10.1093/brain/awad220.
[28]
OLIVEIRA K B, DE SOUZA F M A, DE SÁ L B M, et al. Potential mechanisms underlying COVID-19-mediated central and peripheral demyelination: roles of the RAAS and ADAM-17[J]. Mol Neurobiol, 2025, 62(1): 1151-1164. DOI: 10.1007/s12035-024-04329-8.
[29]
ZAHR N M, PFEFFERBAUM A. Serum albumin and white matter hyperintensities[J/OL]. Transl Psychiatry, 2024, 14: 233 [2025-02-01]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11144249. DOI: 10.1038/s41398-024-02953-5.
[30]
MANOLIS A A, MANOLIS T A, MELITA H, et al. Low serum albumin: a neglected predictor in patients with cardiovascular disease[J]. Eur J Intern Med, 2022, 102: 24-39. DOI: 10.1016/j.ejim.2022.05.004.
[31]
PARHI K K, VIJAYASAMUNDEESWARI C K, KANCHAN R K, et al. Association of serum albumin and C-reactive protein with outcomes in ESRD patients undergoing hemodialysis at a tertiary care center in Salem, Tamil Nadu[J]. J Pharm Bioallied Sci, 2024, 16(Suppl 5): S4540-S4543. DOI: 10.4103/jpbs.jpbs_1147_24.
[32]
KIM J W, BYUN M S, LEE J H, et al. Serum albumin and beta-amyloid deposition in the human brain[J/OL]. Neurology, 2020, 95(7): e815-e826 [2024-04-22]. https://pmc.ncbi.nlm.nih.gov/articles/PMC7605506. DOI: 10.1212/wnl.0000000000010005.
[33]
WEI C S, YAN C Y, YU X R, et al. Association between white matter hyperintensities and chronic kidney disease: a systematic review and meta-analysis[J/OL]. Front Med (Lausanne), 2022, 9: 770184 [2024-04-22]. https://pmc.ncbi.nlm.nih.gov/articles/PMC9112853. DOI: 10.3389/fmed.2022.770184.
[34]
PRINS N D, SCHELTENS P. White matter hyperintensities, cognitive impairment and dementia: an update[J]. Nat Rev Neurol, 2015, 11(3): 157-165. DOI: 10.1038/nrneurol.2015.10.

PREV A study on differences of regional homogeneity on brain function between cerebral small vessel disease patients with and without cognitive impairment
NEXT Study of white matter function in patients with frontotemporal dementia based on long-ranges functional connectivity density
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn