Diffusion tensor magnetic resonance imaging in the diagnosis of white matter lesion in middle-aged patients with uncomplicated essential hypertension

Diffusion tensor magnetic resonance imaging (DT-MRI) is the only noninvasive technique that makes it possible to study white matter microstructure in vivo and to quantify the images obtained.

Objective: to study white matter in middle-aged treatment-naХve patients with uncomplicated grade 1–2 essential hypertension (EH), by using DT-MRI.

Patients and methods. The investigation enrolled 82 people aged 40–59 years (41 patients with EH and 41 healthy individuals (a control group)). Twenty-four blood pressure monitoring and brain MRI were performed in different modes (T1 MPRAGE, T2 TSE, T2 FLAIR, and DTI).

Results. White matter hyperintensities (WMHs) were found in 7.3% of the healthy individuals and in 53.7% of the hypertensive patients (p=0.0002). The latter had significantly lower fractional anisotropy (FA) values in the white matter of the left inferior frontal gyrus than the healthy individuals (0.39±0.06 and 0.45±0.09, respectively; p<0.001). FA was lower in the hypertensive patients than in the healthy individuals not only in the presence of WMHs (the left inferior frontal gyrus white matter was 0.397±0.071 and 0.45±0.09, respectively; p=0.009; the genu of the corpus callosum was 0.79±0.04 and 0.81±0.05, respectively; p=0.045), but also in the absence of WMHs (the left inferior frontal gyrus white matter was 0.378±0.073 and 0.45±0.09, respectively; p=0.0007). Discussion. The treatment-naХve patients with uncomplicated grade 1–2 EH with short-term (2,3 year) duration were found to have significantly lower FA values in the left inferior frontal gyrus white matter than the healthy normotensive subjects of the same age. Thus, the microstructural integrity of white matter is impaired in middle-aged hypertensive patients even at the earliest disease stages.

Conclusion. Middle-aged treatment-naive patients with uncomplicated grade 1–2 EH have lower FA in the left inferior frontal gyrus white matter even in the absence of WMHs. 

1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7): 689-701. doi: 10.1016/S1474-4422(10)70104-6.

2. De Leeuw FE, de Groot JC, Achten E, et al. Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study-the Rotterdam Scan Study. J Neurol Neurosurg Psychiatry. 2001 Jan; 70(1):9-14.

3. De Leeuw FE, de Groot JC, Oudkerk M, et al. Hypertension and cerebral white matter lesions in a prospective cohort study. Brain. 2002 Apr;125(Pt 4):765-72.

4. Longstreth WT Jr, Manolio TA, Arnold A, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: the Cardiovascular Health Study. Stroke. 1996 Aug;27(8):1274-82.

5. De Groot JC, de Leeuw FE, Breteler MM. Cognitive correlates of cerebral white matter changes. J Neural Transm Suppl. 1998;53:41-67.

6. De Groot JC, de Leeuw FE, Oudkerk M, et al. Periventricular cerebral white matter lesions predict rate of cognitive decline. Ann Neurol. 2002 Sep;52(3):335-41. doi:10.1002/ana.10294

7. Gons RA, de Laat KF, van Norden AGW, et al. Hypertension and cerebral diffusion tensor imaging in small vessel disease. Stroke. 2010 Dec; 41(12):2801-6. doi: 10.1161/STROKEAHA.110.27-32597237. Epub 2010 Oct 28.

8. Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurol Sci. 2017 Sep;38(9):1683-1689. doi: 10.1007/s10072-0173038-y. Epub 2017 Jul 5.

9. Fazekas F, Schmidt R, Kleinert R, et al. The spectrum of age-associated brain abnormalities: their measurement and histopathological correlates. J Neural Transm Suppl. 1998; 53:31-9.

10. Le Bihan D, van Zijl P. From the diffusion coefficient to the diffusion tensor. NMR Biomed. 2002 Nov-Dec;15(7-8):431-4. doi:10.1002/nbm.798

11. Kulikova SN, Bryukhov VV, Peresedova A, et al. Diffusion tensor magnetic resonance imaging and tractography in multiple sclerosis: a literature review. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(2-2):52–9. (In Russ.).

12. Launer LJ, Lewis CE, Schreiner PJ, et al. Vascular factors and multiple measures of early brain health: CARDIA brain MRI study. PLoS One. 2015;10(3):e0122138. doi: 10.1371/journal.pone.0122138.

13. Burgmans S, van Boxtel MP, Gronenschild EH, et al. Multiple indicators of agerelated differences in cerebral white matter and the modifying effects of hypertension. Neuroimage. 2010 Feb 1;49(3):2083-93. doi: 10.1016/j.neuroimage.2009.10.035. Epub 2009 Oct 19.

14. Kennedya KM, Raz N. Pattern of normal age-related regional differences in white matter microstructure is modified by vascular risk. Brain Res. 2009 Nov 10;1297:41-56. doi: 10.1016/j. brainres.2009.08.058. Epub 2009 Aug 25.

15. Lawrence AJ, Patel B, Morris RJ, et al. Mechanisms of cognitive impairment in cerebral small vessel disease: multimodal MRI results from the St George's cognition and neuroimaging in stroke (SCANS) study. PLoS One. 2013;8(4):e61014. doi: 10.1371/journal.pone.0061014.

16. Yoshikawa K, Nakata Y, Yamada K, Nakagawa M. Early pathological changes in the parkinsonian brain demonstrated by diffusion tensor MRI. J Neurol Neurosurg Psychiatry. 2004 Mar;75(3):481-4. doi: 10.1136/jnnp.2003.021873.

17. Dobrynina LA, Konovalov RN, Kremneva EI, Kadykov AS. Principles of visualization of diffusion tensor and its application in neurology. MRI in evaluation of motor recovery of patients with chronic supratentorial infarcts. Annaly klinicheskoi i eksperimental'noi nevrologii. 2012;6(2):4–10. (In Russ.).

18. Kitaev SV, Popova TA. Principles of diffuse tensor visualization and its application in neurology. Annaly klinicheskoi i eksperimental'noi nevrologii. 2012;6(1):48–53. (In Russ.).

19. Gattellaro G, Minati L, Grisoli M, et al. White Matter Involvement in Idiopathic Parkinson Disease: A Diffusion Tensor Imaging Study. AJNR Am J Neuroradiol. 2009 Jun;30(6): 1222-6. doi: 10.3174/ajnr.A1556. Epub 2009 Apr 2.

20. Jones D, Lythgoe D, Horsfield M, et al. Characterization of white matter damage in ischaemic leukoaraiosis with diffusion tensor MRI. Stroke. 1999 Feb;30(2):393-7.

21. Chabriat H, Pappata S, Poupon C, et al. Clinical severity in CADASIL related to ultrastructural damage in white matter: in vivo study with diffusion tensor MRI. Stroke. 1999 Dec; 30(12):2637-43.

22. Nitkunan A, Charlton RA, McIntyre DJ, et al. Diffusion tensor imaging and MR spectroscopy in hypertension and presumed cerebral small vessel disease. Magn Reson Med. 2008 Mar;59(3):528-34. doi: 10.1002/mrm.21461.