Diffusion tensor imaging (DTI) and its clinical correlates in drug naïve Wilson's disease
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Rakesh Jadav1, Jitender Saini, Sanjib Sinha
1Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560 029, Karnataka, India.
Abstract:
The purpose is to evaluate white matter (WM) abnormalities in Wilson's disease (WD) using the technique of diffusion tensor imaging (DTI). The prospective case-control study comprised of 15 drug-naïve patients with WD and 15 controls. The phenotype of subjects was evaluated. The DTI/conventional MRI was acquired (3T MRI): Fractional anisotropy (FA) and mean diffusivity (MD) values were extracted from regions of interest placed in pons, midbrain, bilateral frontal and occipital cerebral white matter, bilateral internal capsules (IC), middle cerebellar peduncles (MCP) and corpus callosum (CC). Six patients showed lobar WM signal changes on T(2)-Weighted (T2W)/Fluid attenuation inversion recovery (FLAIR) images while remaining had normal appearing WM. MD was significantly increased in the lobar WM, bilateral IC and midbrain of WD patients. FA was decreased in the frontal and occipital WM, bilateral IC, midbrain and pons. Normal-appearing white matter on FLAIR images showed significantly increased MD and decreased FA values in both frontal and occipital lobar WM and IC compared with those in controls. Correlation of clinical scores and DTI metrics revealed positive correlation between neurological symptom score (NSS) and MD of anterior limb of right internal capsule, Chu stage and MD of frontal and occipital WM. Negative correlation was observed between the Modified Schwab and England Activities of Daily Living (MSEADL) score and MD of bilateral frontal and occipital WM and IC. This is the probably the first study to reveal widespread alterations in WM by DTI metrics in drug naïve WD. DTI analysis revealed lobar WM abnormalities which is less frequently noted on conventional MRI and suggests widespread WM abnormalities in WD. It may be valuable in assessing the true extent of involvement and therefore the severity of the illness.
Insights
Diffusion tensor imaging (DTI) reveals widespread white matter (WM) abnormalities in drug-naïve Wilson
Area of Science:
- Neuroimaging
- Neurology
- Medical Physics
Background:
- Wilson's disease (WD) is a genetic disorder characterized by copper accumulation.
- White matter (WM) abnormalities are known in WD, but their full extent is unclear.
- Conventional MRI may not detect subtle WM changes.
Purpose of the Study:
- To evaluate white matter (WM) abnormalities in drug-naïve Wilson's disease (WD) patients using diffusion tensor imaging (DTI).
- To correlate DTI metrics with clinical scores to assess disease severity.
Main Methods:
- Prospective case-control study with 15 drug-naïve WD patients and 15 controls.
- Acquisition of 3T MRI including DTI and conventional sequences (T2W/FLAIR).
- Analysis of fractional anisotropy (FA) and mean diffusivity (MD) in various brain regions.
Main Results:
- WD patients showed significantly increased MD and decreased FA in multiple WM regions, including those appearing normal on conventional MRI.
- Abnormalities were noted in the frontal and occipital WM, internal capsules, and midbrain.
- Clinical scores correlated with DTI metrics, indicating MD's association with neurological symptoms and daily living activities.
Conclusions:
- DTI is sensitive to widespread WM abnormalities in drug-naïve WD, even in areas with normal conventional MRI appearance.
- DTI metrics can reveal the true extent of WM involvement in WD.
- DTI may serve as a valuable tool for assessing WD severity.
