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. 2021 Jul 5:13:620763.
doi: 10.3389/fnagi.2021.620763. eCollection 2021.

Measurement of Cortical Atrophy and Its Correlation to Memory Impairment in Patients With Asymptomatic Carotid Artery Stenosis Based on VBM-DARTEL

Peijiong Wang  1   2   3   4 , Husule Cai  1   2   3   4 , Rutao Luo  5 , Zihao Zhang  6 , Dong Zhang  1   2   3   4 , Yan Zhang  1   2   3   4
Affiliations

Measurement of Cortical Atrophy and Its Correlation to Memory Impairment in Patients With Asymptomatic Carotid Artery Stenosis Based on VBM-DARTEL

Peijiong Wang et al. Front Aging Neurosci. .

Abstract

Objective: Severe carotid artery stenosis (CAS) can lead to atrophy of gray matter (GM) and memory impairment; however, the underlying mechanism is unknown. Thus, we aimed to identify memory impairment and GM atrophy and explore the possible correlation between them in patients with asymptomatic severe CAS.

Methods: Twenty-four patients with asymptomatic severe CAS and 10 healthy controls completed the mini-mental state examination (MMSE) and clinical memory scale (CMS) and underwent 7T magnetic resonance imaging (MRI) scan. Field intensity inhomogeneities were corrected. Images were processed using VBM8, and GM images were flipped. First, 11 flipped and 10 non-flipped images of patients with unilateral CAS and 5 flipped and 5 non-flipped images of controls were pre-processed using DARTEL algorithm and analyzed using an analysis of variance (ANOVA). Second, flipped and non-flipped images of unilateral patients were similarly pre-processed and analyzed using the paired t-test. Third, pre-processed non-flipped GM images and CMS scores of 24 patients were analyzed by multiple regression analysis. Nuisance variables were corrected accordingly.

Results: Basic information was well matched between patients and controls. MMSE scores of patients were in the normal range; however, memory function was significantly reduced (all P < 0.05). GM volumes of patients were significantly reduced in the anterior circulation regions. The stenosis-side hemispheres showed greater atrophy. GM volumes of the left pars opercularis, pars triangularis, and middle frontal gyrus were strongly positively correlated with the total scores of CMS (all r > 0.7, P = 0.001). Additionally, the left middle frontal gyrus was strongly positively correlated with associative memory (r = 0.853, P = 0.001). The left pars opercularis was moderately positively correlated with semantic memory (r = 0.695, P = 0.001).

Conclusion: Patients with asymptomatic CAS suffer from memory impairment. Bilateral anterior circulation regions showed extensive atrophy. The hemisphere with stenosis showed severer atrophy. Memory impairment in patients may be related to atrophy of the left frontal gyrus and atrophy of different regions may result in different memory impairments.

Keywords: 7T-MRI; VBM analysis; asymptomatic carotid stenosis; cerebral gray matter atrophy; memory deficiency.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Diagram of stenosis-side hemisphere vs. contralateral hemisphere. First, in each unilateral CAS patient, ipsilateral hemisphere and contralateral hemisphere cannot be paired and compared directly. So, the GM image of each patient needs to be flipped in the right–left orientation and then each patient had one non-flipped image and one paired flipped image. In this way, each patient had a stenosis hemisphere and a contralateral image on the left side when his/her non-flipped image and flipped image were paired together. Thus, patients’ non-flipped images and flipped GM images were analyzed by paired t-test following mode of contralateral hemisphere vs. stenosis-side hemisphere on the left side defined by left-hemisphere mask.
FIGURE 2
FIGURE 2
Asymptomatic CAS patients vs. healthy controls. (A) Three-dimensional image. (B) Slice view. Cortical atrophy was observed in bilateral frontal, temporal, and parietal lobes, but occipital lobe and cerebellum were barely affected. L: left, R: right.
FIGURE 3
FIGURE 3
Stenosis-side hemisphere vs. contralateral hemisphere. (a) Three-dimensional image. (b) Slice view. The stenosis-side hemisphere suffered more severe atrophy on inferior parietal lobule and cingulate gyrus, compared with contralateral hemisphere. L: left, R: right.
FIGURE 4
FIGURE 4
The cortex related with general memory function and their Pearson correlation coefficients. (a) Three-dimensional image. (b) Correlation between the total scores of CMS and regional relative GM volumes. (c) Slice view. GM volumes of the left pars opercularis gyri frontalis inferioris, left pars triangularis gyri frontalis inferioris, and the frontal part of left middle frontal gyrus were positively related with the total clinical memory scores closely. L: left, R: right.
FIGURE 5
FIGURE 5
The cortex related to associative memory and their Pearson correlation coefficients. (a) Three-dimensional image. (b) Correlation between associative scores and regional relative GM volumes. (c) Slice view. GM volumes of the anterior medial frontal gyrus cortex were positively related with the associative memory scores. L: left, R: right.
FIGURE 6
FIGURE 6
The cortex related to semantic memory and their Pearson correlation coefficients. (a) Three-dimensional image. (b) Correlation between semantic memory scores and regional relative GM volumes. (c) Slice view. GM volumes of the posterior inferior frontal gyrus were positively related with the semantic memory scores. L: left, R: right.
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