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Shades of white: diffusion properties of T1- and FLAIR-defined white matter signal abnormalities differ in stages from cognitively normal to dementia

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The underlying pathology of white matter signal abnormalities (WMSAs) is heterogeneous and may vary dependent on the magnetic resonance imaging contrast used to define them. We investigated differences in white matter diffusivity as an indicator for white matter integrity underlying WMSA based on T1-weighted and fluid-attenuated inversion recovery (FLAIR) imaging contrast. In addition, we investigated which white matter region of interest (ROI) could predict clinical diagnosis best using diffusion metrics. One hundred three older individuals with varying cognitive impairment levels were included and underwent neuroimaging. Diffusion metrics were extracted from WMSA areas based on T1 and FLAIR contrast and from their overlapping areas, the border surrounding the WMSA and the normal-appearing white matter (NAWM). Regional diffusivity differences were calculated with linear mixed effects models. Multinomial logistic regression determined which ROI diffusion values classified individuals best into clinically defined diagnostic groups. T1-based WMSA showed lower white matter integrity compared to FLAIR WMSA-defined regions. Diffusion values of NAWM predicted diagnostic group best compared to other ROI's. To conclude, T1- or FLAIR-defined WMSA provides distinct information on the underlying white matter integrity associated with cognitive decline. Importantly, not the "diseased" but the NAWM is a potentially sensitive indicator for cognitive brain health status.

    Research areas

  • Journal Article, SURFACE-BASED ANALYSIS, CORTICAL SURFACE, SMALL VESSEL DISEASE, MULTIPLE-SCLEROSIS LESIONS, MRI, MAGNETIC-RESONANCE IMAGES, White matter hyper intensities, TEMPORAL-LOBE ATROPHY, ALZHEIMERS ASSOCIATION WORKGROUPS, White matter, Diffusion tensor imaging, PARTICIPANTS AGED 24-81, HUMAN CEREBRAL-CORTEX, Aging, Alzheimer's disease, AGING BRAIN, Neuroimaging, Humans, Middle Aged, Male, Cognition, White Matter/diagnostic imaging, Cognitive Aging/physiology, Aged, 80 and over, Female, Alzheimer Disease/diagnostic imaging, Severity of Illness Index, Disease Progression, Dementia/diagnostic imaging, Diffusion Magnetic Resonance Imaging, Aged, Cognitive Dysfunction/diagnostic imaging
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Original languageEnglish
Pages (from-to)48-58
Number of pages11
JournalNeurobiology of Aging
Early online date5 Apr 2018
Publication statusPublished - Aug 2018