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<meta name="DC.Title" content="White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5042" />
<meta name="DC.Date" content="2016-12-15" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Increasing DTI studies have demonstrated that white matter microstructural abnormalities play an important role in type 2 diabetes mellitus–related cognitive impairment. In this study, the diffusional kurtosis imaging method was used to investigate WM microstructural alterations in patients with type 2 diabetes mellitus and to detect associations between diffusional kurtosis imaging metrics and clinical/cognitive measurements.

MATERIALS AND METHODS: Diffusional kurtosis imaging and cognitive assessments were performed on 58 patients with type 2 diabetes mellitus and 58 controls. Voxel-based intergroup comparisons of diffusional kurtosis imaging metrics were conducted, and ROI-based intergroup comparisons were further performed. Correlations between the diffusional kurtosis imaging metrics and cognitive/clinical measurements were assessed after controlling for age, sex, and education in both patients and controls.

RESULTS: Altered diffusion metrics were observed in the corpus callosum, the bilateral frontal WM, the right superior temporal WM, the left external capsule, and the pons in patients with type 2 diabetes mellitus compared with controls. The splenium of the corpus callosum and the pons had abnormal kurtosis metrics in patients with type 2 diabetes mellitus. Additionally, altered diffusion metrics in the right prefrontal WM were significantly correlated with disease duration and attention task performance in patients with type 2 diabetes mellitus.

CONCLUSIONS: With both conventional diffusion and additional kurtosis metrics, diffusional kurtosis imaging can provide additional information on WM microstructural abnormalities in patients with type 2 diabetes mellitus. Our results indicate that WM microstructural abnormalities occur before cognitive decline and may be used as neuroimaging markers for predicting the early cognitive impairment in patients with type 2 diabetes mellitus.

### Abbreviations

AD
:   axial diffusivity
AK
:   axial kurtosis
CC
:   corpus callosum
DKI
:   diffusional kurtosis imaging
FA
:   fractional anisotropy
HbA1c
:   glycosylated hemoglobin
lEC
:   left external capsule
MD
:   mean diffusivity
MK
:   mean kurtosis
RD
:   radial diffusivity
rPF_WM
:   right prefrontal white matter
RK
:   radial kurtosis
RT of ANT
:   reaction time of Attention Network Test
T2DM
:   type 2 diabetes mellitus" />
<meta name="DC.Contributor" content="Y. Xie" />
<meta name="DC.Contributor" content="Y. Zhang" />
<meta name="DC.Contributor" content="W. Qin" />
<meta name="DC.Contributor" content="S. Lu" />
<meta name="DC.Contributor" content="C. Ni" />
<meta name="DC.Contributor" content="Q. Zhang" />
<meta name="article:published_time" content="2016-12-15" />
<meta name="article:section" content="FUNCTIONAL" />
<meta name="citation_title" content="White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Increasing DTI studies have demonstrated that white matter microstructural abnormalities play an important role in type 2 diabetes mellitus–related cognitive impairment. In this study, the diffusional kurtosis imaging method was used to investigate WM microstructural alterations in patients with type 2 diabetes mellitus and to detect associations between diffusional kurtosis imaging metrics and clinical/cognitive measurements.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Diffusional kurtosis imaging and cognitive assessments were performed on 58 patients with type 2 diabetes mellitus and 58 controls. Voxel-based intergroup comparisons of diffusional kurtosis imaging metrics were conducted, and ROI-based intergroup comparisons were further performed. Correlations between the diffusional kurtosis imaging metrics and cognitive/clinical measurements were assessed after controlling for age, sex, and education in both patients and controls.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Altered diffusion metrics were observed in the corpus callosum, the bilateral frontal WM, the right superior temporal WM, the left external capsule, and the pons in patients with type 2 diabetes mellitus compared with controls. The splenium of the corpus callosum and the pons had abnormal kurtosis metrics in patients with type 2 diabetes mellitus. Additionally, altered diffusion metrics in the right prefrontal WM were significantly correlated with disease duration and attention task performance in patients with type 2 diabetes mellitus.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;With both conventional diffusion and additional kurtosis metrics, diffusional kurtosis imaging can provide additional information on WM microstructural abnormalities in patients with type 2 diabetes mellitus. Our results indicate that WM microstructural abnormalities occur before cognitive decline and may be used as neuroimaging markers for predicting the early cognitive impairment in patients with type 2 diabetes mellitus.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="Y. Xie" />
<meta name="citation_author_institution" content="From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0001-5986-4610" />
<meta name="citation_author" content="Y. Zhang" />
<meta name="citation_author_institution" content="From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0003-1903-3737" />
<meta name="citation_author" content="W. Qin" />
<meta name="citation_author_institution" content="From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-9121-8296" />
<meta name="citation_author" content="S. Lu" />
<meta name="citation_author_institution" content="From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-7387-2577" />
<meta name="citation_author" content="C. Ni" />
<meta name="citation_author_institution" content="From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-8668-8648" />
<meta name="citation_author" content="Q. Zhang" />
<meta name="citation_author_institution" content="From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China." />
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<meta name="twitter:title" content="White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Increasing DTI studies have demonstrated that white matter microstructural abnormalities play an important role in type 2 diabetes mellitus–related cognitive impairment. In this study, the diffusional kurtosis imaging method was used to investigate WM microstructural alterations in patients with type 2 diabetes mellitus and to detect associations between diffusional kurtosis imaging metrics and clinical/cognitive measurements.

MATERIALS AND METHODS: Diffusional kurtosis imaging and cognitive assessments were performed on 58 patients with type 2 diabetes mellitus and 58 controls. Voxel-based intergroup comparisons of diffusional kurtosis imaging metrics were conducted, and ROI-based intergroup comparisons were further performed. Correlations between the diffusional kurtosis imaging metrics and cognitive/clinical measurements were assessed after controlling for age, sex, and education in both patients and controls.

RESULTS: Altered diffusion metrics were observed in the corpus callosum, the bilateral frontal WM, the right superior temporal WM, the left external capsule, and the pons in patients with type 2 diabetes mellitus compared with controls. The splenium of the corpus callosum and the pons had abnormal kurtosis metrics in patients with type 2 diabetes mellitus. Additionally, altered diffusion metrics in the right prefrontal WM were significantly correlated with disease duration and attention task performance in patients with type 2 diabetes mellitus.

CONCLUSIONS: With both conventional diffusion and additional kurtosis metrics, diffusional kurtosis imaging can provide additional information on WM microstructural abnormalities in patients with type 2 diabetes mellitus. Our results indicate that WM microstructural abnormalities occur before cognitive decline and may be used as neuroimaging markers for predicting the early cognitive impairment in patients with type 2 diabetes mellitus.

### Abbreviations

AD
:   axial diffusivity
AK
:   axial kurtosis
CC
:   corpus callosum
DKI
:   diffusional kurtosis imaging
FA
:   fractional anisotropy
HbA1c
:   glycosylated hemoglobin
lEC
:   left external capsule
MD
:   mean diffusivity
MK
:   mean kurtosis
RD
:   radial diffusivity
rPF_WM
:   right prefrontal white matter
RK
:   radial kurtosis
RT of ANT
:   reaction time of Attention Network Test
T2DM
:   type 2 diabetes mellitus" />
<meta name="og-title" property="og:title" content="White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2016/12/15/ajnr.A5042" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Increasing DTI studies have demonstrated that white matter microstructural abnormalities play an important role in type 2 diabetes mellitus–related cognitive impairment. In this study, the diffusional kurtosis imaging method was used to investigate WM microstructural alterations in patients with type 2 diabetes mellitus and to detect associations between diffusional kurtosis imaging metrics and clinical/cognitive measurements.

MATERIALS AND METHODS: Diffusional kurtosis imaging and cognitive assessments were performed on 58 patients with type 2 diabetes mellitus and 58 controls. Voxel-based intergroup comparisons of diffusional kurtosis imaging metrics were conducted, and ROI-based intergroup comparisons were further performed. Correlations between the diffusional kurtosis imaging metrics and cognitive/clinical measurements were assessed after controlling for age, sex, and education in both patients and controls.

RESULTS: Altered diffusion metrics were observed in the corpus callosum, the bilateral frontal WM, the right superior temporal WM, the left external capsule, and the pons in patients with type 2 diabetes mellitus compared with controls. The splenium of the corpus callosum and the pons had abnormal kurtosis metrics in patients with type 2 diabetes mellitus. Additionally, altered diffusion metrics in the right prefrontal WM were significantly correlated with disease duration and attention task performance in patients with type 2 diabetes mellitus.

CONCLUSIONS: With both conventional diffusion and additional kurtosis metrics, diffusional kurtosis imaging can provide additional information on WM microstructural abnormalities in patients with type 2 diabetes mellitus. Our results indicate that WM microstructural abnormalities occur before cognitive decline and may be used as neuroimaging markers for predicting the early cognitive impairment in patients with type 2 diabetes mellitus.

### Abbreviations

AD
:   axial diffusivity
AK
:   axial kurtosis
CC
:   corpus callosum
DKI
:   diffusional kurtosis imaging
FA
:   fractional anisotropy
HbA1c
:   glycosylated hemoglobin
lEC
:   left external capsule
MD
:   mean diffusivity
MK
:   mean kurtosis
RD
:   radial diffusivity
rPF_WM
:   right prefrontal white matter
RK
:   radial kurtosis
RT of ANT
:   reaction time of Attention Network Test
T2DM
:   type 2 diabetes mellitus" />
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      <h1 class="highwire-cite-title" id="page-title">White Matter Microstructural Abnormalities in Type 2 Diabetes Mellitus: A Diffusional Kurtosis Imaging Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Y. Xie</span>, <span class="highwire-citation-author" data-delta="1">Y. Zhang</span>, <span class="highwire-citation-author" data-delta="2">W. Qin</span>, <span class="highwire-citation-author" data-delta="3">S. Lu</span>, <span class="highwire-citation-author" data-delta="4">C. Ni</span> and <span class="highwire-citation-author" data-delta="5">Q. Zhang</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2016,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5042 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-787--61320795488" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Y. Xie </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BXie%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Xie%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BXie%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5986-4610" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Xie</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Y. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1903-3737" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Zhang</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">W. Qin </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.%2BQin%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Qin%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AW.%2BQin%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9121-8296" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W. Qin</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">S. Lu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BLu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lu%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BLu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7387-2577" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Lu</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">C. Ni </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BNi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ni%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BNi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8668-8648" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Ni</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Q. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Y.X., Y.Z., W.Q., Q.Z.), Tianjin Medical University General Hospital, Tianjin, China; and Departments of Radiology (S.L.) and Cardiology (C.N.), Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Q.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20Q&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AQ.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9501-5904" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Q. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Increasing DTI studies have demonstrated that white matter microstructural abnormalities play an important role in type 2 diabetes mellitus–related cognitive impairment. In this study, the diffusional kurtosis imaging method was used to investigate WM microstructural alterations in patients with type 2 diabetes mellitus and to detect associations between diffusional kurtosis imaging metrics and clinical/cognitive measurements.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> Diffusional kurtosis imaging and cognitive assessments were performed on 58 patients with type 2 diabetes mellitus and 58 controls. Voxel-based intergroup comparisons of diffusional kurtosis imaging metrics were conducted, and ROI-based intergroup comparisons were further performed. Correlations between the diffusional kurtosis imaging metrics and cognitive/clinical measurements were assessed after controlling for age, sex, and education in both patients and controls.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> Altered diffusion metrics were observed in the corpus callosum, the bilateral frontal WM, the right superior temporal WM, the left external capsule, and the pons in patients with type 2 diabetes mellitus compared with controls. The splenium of the corpus callosum and the pons had abnormal kurtosis metrics in patients with type 2 diabetes mellitus. Additionally, altered diffusion metrics in the right prefrontal WM were significantly correlated with disease duration and attention task performance in patients with type 2 diabetes mellitus.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> With both conventional diffusion and additional kurtosis metrics, diffusional kurtosis imaging can provide additional information on WM microstructural abnormalities in patients with type 2 diabetes mellitus. Our results indicate that WM microstructural abnormalities occur before cognitive decline and may be used as neuroimaging markers for predicting the early cognitive impairment in patients with type 2 diabetes mellitus.</p></div></div><div class="section glossary" id="glossary-1"><h3>Abbreviations</h3><dl id="def-list-1"><dt id="def-item-1">AD<span class="def-item-dt-sep"></span></dt><dd>axial diffusivity<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">AK<span class="def-item-dt-sep"></span></dt><dd>axial kurtosis<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CC<span class="def-item-dt-sep"></span></dt><dd>corpus callosum<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">DKI<span class="def-item-dt-sep"></span></dt><dd>diffusional kurtosis imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">FA<span class="def-item-dt-sep"></span></dt><dd>fractional anisotropy<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">HbA1c<span class="def-item-dt-sep"></span></dt><dd>glycosylated hemoglobin<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">lEC<span class="def-item-dt-sep"></span></dt><dd>left external capsule<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">MD<span class="def-item-dt-sep"></span></dt><dd>mean diffusivity<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">MK<span class="def-item-dt-sep"></span></dt><dd>mean kurtosis<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">RD<span class="def-item-dt-sep"></span></dt><dd>radial diffusivity<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">rPF_WM<span class="def-item-dt-sep"></span></dt><dd>right prefrontal white matter<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">RK<span class="def-item-dt-sep"></span></dt><dd>radial kurtosis<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">RT of ANT<span class="def-item-dt-sep"></span></dt><dd>reaction time of Attention Network Test<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">T2DM<span class="def-item-dt-sep"></span></dt><dd>type 2 diabetes mellitus</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-equal" id="fn-1"><p id="p-1">Y. Xie and Y. Zhang contributed equally to this work.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2017 American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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