FEATURES OF EARLY MRI DIAGNOSIS OF CEREBRAL SMALL VESSEL DISE ASE IN PATIENTS WITH ARTERIAL HYPERTENSION AND DIABETES MELLITUS TYPE 2
Keywords:type 2 diabetes mellitus, arterial hypertension, small vessel disease, MRI.
Aim: This study tested the hypothesis about the possibility of effective use of MRI in the early diagnosis of structural changes in the white matter of the brain (WHM) in patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM2) with AH. Material and methods. MRI was performed on an Ingenia 3T tomograph (Philips). 22 patients — T2DM with AH and 25 patients with AH (mean age — (57.9 ± 6.1) years) were examined. Results. The small vessel disease (SVD) burden in patients with AH and type 2 diabetes is greater (6.1 ± 0.71) than in patients with AH (4.24 ± 0.58; p = 0.049). Part of the revealed periventricular leuko- Проблеми ендокринної патології №4, 2020 47 Клінічна ендокринологія araiosis — 81.8% in patients of group I; 36% of patients of group II. Multiple consolidating leukoaraiosis foci in the WHM and basal ganglia were visualized in 40.9% of cases in group I (12% in cases in group II). Extensive consolidated zones of subcortical leukoaraiosis were found in 2 patients with AH and CD2. In 2 patients with CD2, lacunar infarctions were detected simultaneously with widespread areas of hyperintensity of WHM. There were no signs of cortex or WHM atrophy and MRI signs of intracerebral microhemorrhages. In the upper longitudinal fascicles, semi-oval centers, periventricular zones of the WHM and basal ganglia, the fractional anisotropy (FA) in T2DM with AH is lower than in patients with AH (p < 0.049–0.0001). In T2DM with AH, the mean diffusion (SD) significantly exceeds the control values and the values of the group of AH patients in the basal ganglia, periventricular zones and the knee of the corpus callosum (p < 0.05–0.0001). In patients with hypertension, the increase of SD was also significant, but less than in patients of the main group. Conclusions. It has been proven that MRI is an effective early diagnosis method for structural changes in WHM which develop as a result of a concomitant disease of AH and T2D. The prevalence of gliosis and neurodegeneration (increase in FA) should be considered characteristic of diabetic cerebral microangiopathy. Hypertensive SVD is characterized by less pronounced manifestations of gliosis, enlargement of the perivascular spaces, and an increase in SD.
American Diabetes Association. Diabetes Care 2018;41(1): S86-S104. doi: http://doi.org/10.2337/dс18- S009.
Barrett EJ, Liu Z, Khamaisi M, et al. J Clin Endocrinol Metab 2017; 102(12): 4343-4410. doi: http://doi.org/10.1210/jc.2017-01922.
Mikhaylichenko ТЕ. Mezhdunar Endocrinol Zhurn 2017; 13(7): 506-514. doi: http://doi.org/10.22141/2224-07188.8.131.527.115750.
Zhuoa Ya, Fangc F, Lua L, et al. NeuroImage: Clinical 2019; 24: 101945. doi: http://doi.org/10.1016/j.nicl.2019.101945.
Reijmer Ya, Brundel M, Bresser J, et al. Diabetes Care 2013; 36: 137-144. doi: http://doi.org/10.2337/dc12-0493.
Blair GW, Hernandez MV, Thrippleton MJ, et al. Curr Treat Options Cardio Med 2017; 19: 56. doi: http://doi.org/10.1007/s11936-017-0555-1.
Mishchenko TS, Nikishkova SM, Mishchenko VN. Ukr Visn Psykhonevrol 2016; 24(3): 11-16.
Grajauskas L, Guo H, D’Arcy RCN, Song X. Aging Med 2018; 1: 55-63. doi: http://doi.org/10.1002/agm2.12014.
Martorell SD, Blбzquez MC, Figueredo DG, et al. Radiologia 2012; 54(4): 321-335.
Liang Y, Zhang H, Tan X, et al. Front Neurosci 2019; 13: 63. doi: http://doi.org/10.3389/fnins.2019.00063.
Levin OS. Consillium Medicum 2007; 8: 72-79.
Yanishevsky SN, Gaikova ON, Onischenko LC. Vestn Ros Voen-Med Akad 2013; 4 (44): 106.