Frontiers in neurology · 2026
Elevated peak width of skeletonized mean diffusivity in patients with end-stage kidney disease: evidence of diffuse white matter microstructural injury.
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Ko Junghae, Park Bong Soo, Heo Chang Min, Park Sihyung, Yi Jiyae, Lee Ho-Joon, Lee Dong Ah, Park Kang Min
Аннотация
BACKGROUND: Peak width of skeletonized mean diffusivity (PSMD) is a diffusion tensor imaging-based marker of diffuse white matter microstructural injury that has been associated with cerebral small vessel disease (CSVD). This study aimed to investigate whether patients with end-stage kidney disease (ESKD) exhibit altered PSMD compared with healthy controls.
METHODS: We prospectively enrolled 38 ESKD patients and 38 age- and sex-matched healthy controls. Diffusion tensor imaging (DTI) was performed using a three-tesla MRI scanner in patients with ESKD and healthy controls. We obtained PSMD based on DTI in several steps, including preprocessing, skeletonization, application of a custom mask, and histogram analysis. We compared PSMD between the groups and performed correlation analyses between PSMD and clinical factors.
RESULTS: PSMD was higher in patients with ESKD than in healthy controls (2.945 ± 0.361 vs. 2.552 ± 0.458 × 10-4 mm2/s, p < 0.001). In addition, PSMD positively correlated with age (r = 0.370, p = 0.022). In exploratory subgroup analyses, no statistically significant differences in PSMD were observed according to dialysis modality or the presence of diabetes mellitus.
CONCLUSION: We demonstrated that patients with ESKD exhibited higher PSMD than healthy controls, suggesting diffuse white matter microstructural injury that may be related to CSVD. PSMD may be a useful imaging marker for characterizing diffuse white matter abnormalities in this population, although further studies incorporating conventional CSVD markers, vascular risk-matched controls, and clinical outcome measures are warranted.
METHODS: We prospectively enrolled 38 ESKD patients and 38 age- and sex-matched healthy controls. Diffusion tensor imaging (DTI) was performed using a three-tesla MRI scanner in patients with ESKD and healthy controls. We obtained PSMD based on DTI in several steps, including preprocessing, skeletonization, application of a custom mask, and histogram analysis. We compared PSMD between the groups and performed correlation analyses between PSMD and clinical factors.
RESULTS: PSMD was higher in patients with ESKD than in healthy controls (2.945 ± 0.361 vs. 2.552 ± 0.458 × 10-4 mm2/s, p < 0.001). In addition, PSMD positively correlated with age (r = 0.370, p = 0.022). In exploratory subgroup analyses, no statistically significant differences in PSMD were observed according to dialysis modality or the presence of diabetes mellitus.
CONCLUSION: We demonstrated that patients with ESKD exhibited higher PSMD than healthy controls, suggesting diffuse white matter microstructural injury that may be related to CSVD. PSMD may be a useful imaging marker for characterizing diffuse white matter abnormalities in this population, although further studies incorporating conventional CSVD markers, vascular risk-matched controls, and clinical outcome measures are warranted.