DTI-ALPS index as a predictor of glymphatic system dysfunction in cerebral infarction

Area of Science:

• Neuroscience
• Radiology
• Medical Imaging

Background:

• Cerebral infarction (stroke) significantly impacts patient prognosis and quality of life.
• The glymphatic system (GS) plays a crucial role in waste clearance in the brain.
• GS dysfunction is increasingly recognized as a factor in neurological diseases.

Purpose of the Study:

• To evaluate glymphatic system (GS) dysfunction in cerebral infarction patients using diffusion tensor imaging-along the perivascular space (DTI-ALPS).
• To identify factors associated with impaired glymphatic function following stroke.
• To correlate GS function with patient prognosis.

Main Methods:

• Retrospective study of 82 cerebral infarction patients.
• Classification into good (n=40) and poor (n=42) prognosis groups based on 90-day modified Rankin Scale (mRS) scores.
• Comparison of DTI-ALPS indices (L-ALPS, R-ALPS, mean-ALPS), clinical data, NIHSS, mRS, and infarct location between groups.

Main Results:

• Higher DTI-ALPS values (L-ALPS, R-ALPS, mean-ALPS) were observed in the good prognosis group.
• The good prognosis group showed better psychological recovery (lower HAMD/HAMA scores) and functional status (lower NIHSS, higher GCS/ADL scores) at 90 days.
• DTI-ALPS indices, 90-day mRS, ADL, and GCS scores were independent predictors of poor prognosis and associated with GS dysfunction.

Conclusions:

• Poor prognosis in cerebral infarction is associated with significant glymphatic system dysfunction.
• Glymphatic impairment serves as both a marker and potential contributor to stroke outcomes.
• DTI-ALPS is a valuable tool for assessing GS function and predicting stroke prognosis.