Glymphatic Dysfunction in Patients With Ischemic Stroke

Objectives: Rodent experiments have provided some insight into the changes of glymphatic function in ischemic stroke. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) method offers an opportunity for the noninvasive investigation of the glymphatic system in patients with i...

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Autores principales:	Cheng Hong Toh, Tiing Yee Siow
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	neuroimaging biomarkers ischemic stroke diffusion tensor imaging ALPS (analysis along perivascular space) index glymphatic function Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/1f14a69aeac64375bd7dc6da7107bfaa
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spelling	oai:doaj.org-article:1f14a69aeac64375bd7dc6da7107bfaa2021-11-08T05:12:17ZGlymphatic Dysfunction in Patients With Ischemic Stroke1663-436510.3389/fnagi.2021.756249https://doaj.org/article/1f14a69aeac64375bd7dc6da7107bfaa2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fnagi.2021.756249/fullhttps://doaj.org/toc/1663-4365Objectives: Rodent experiments have provided some insight into the changes of glymphatic function in ischemic stroke. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) method offers an opportunity for the noninvasive investigation of the glymphatic system in patients with ischemic stroke. We aimed to investigate the changes of glymphatic function in ischemic stroke and the factors associated with the changes.Materials and Methods: A total of 50 patients (mean age 56.7 years; 30 men) and 44 normal subjects (mean age 53.3 years; 23 men) who had preoperative diffusion-tensor imaging for calculation of the analysis along the perivascular space (ALPS) index were retrospectively included. Information collected from each patient included sex, age, time since stroke onset, infarct location, hemorrhagic change, infarct volume, infarct apparent diffusion coefficient (ADC), infarct fractional anisotropy (FA), and ALPS index of both hemispheres. Interhemispheric differences in ALPS index (infarct side vs. contralateral normal side) were assessed with a paired t-test in all patients. ALPS index was normalized by calculating ALPS ratios (right-to-left and left-to-right) for comparisons between patients and normal subjects. Comparisons of ALPS ratios between patients and normal subjects were performed using analysis of covariance with adjustments for age and sex. Linear regression analyses were performed to identify factors associated with the ALPS index.Results: In patients, the mean ALPS index ipsilateral to infarct was 1.162 ± 0.126, significantly lower (P < 0.001) than that of the contralateral side (1.335 ± 0.160). The right-to-left ALPS index ratio of patients with right cerebral infarct was 0.84 ± 0.08, significantly lower (P < 0.001) than that of normal subjects (0.95 ± 0.07). The left-to-right ALPS ratio of patients with left cerebral infarct was 0.92 ± 0.09, significantly (P < 0.001) lower than that of normal subjects (1.05 ± 0.08). On multiple linear regression analysis, time since stroke onset (β = 0.794, P < 0.001) was the only factor associated with the ALPS index.Conclusion: The ALPS index showed lower values in ischemic stroke suggesting impaired glymphatic function. Following initial impairment, the ALPS index increased with the time since stroke onset, which is suggestive of glymphatic function recovery.Cheng Hong TohCheng Hong TohTiing Yee SiowFrontiers Media S.A.articleneuroimaging biomarkersischemic strokediffusion tensor imagingALPS (analysis along perivascular space) indexglymphatic functionNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENFrontiers in Aging Neuroscience, Vol 13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	neuroimaging biomarkers ischemic stroke diffusion tensor imaging ALPS (analysis along perivascular space) index glymphatic function Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	neuroimaging biomarkers ischemic stroke diffusion tensor imaging ALPS (analysis along perivascular space) index glymphatic function Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Cheng Hong Toh Cheng Hong Toh Tiing Yee Siow Glymphatic Dysfunction in Patients With Ischemic Stroke
description	Objectives: Rodent experiments have provided some insight into the changes of glymphatic function in ischemic stroke. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) method offers an opportunity for the noninvasive investigation of the glymphatic system in patients with ischemic stroke. We aimed to investigate the changes of glymphatic function in ischemic stroke and the factors associated with the changes.Materials and Methods: A total of 50 patients (mean age 56.7 years; 30 men) and 44 normal subjects (mean age 53.3 years; 23 men) who had preoperative diffusion-tensor imaging for calculation of the analysis along the perivascular space (ALPS) index were retrospectively included. Information collected from each patient included sex, age, time since stroke onset, infarct location, hemorrhagic change, infarct volume, infarct apparent diffusion coefficient (ADC), infarct fractional anisotropy (FA), and ALPS index of both hemispheres. Interhemispheric differences in ALPS index (infarct side vs. contralateral normal side) were assessed with a paired t-test in all patients. ALPS index was normalized by calculating ALPS ratios (right-to-left and left-to-right) for comparisons between patients and normal subjects. Comparisons of ALPS ratios between patients and normal subjects were performed using analysis of covariance with adjustments for age and sex. Linear regression analyses were performed to identify factors associated with the ALPS index.Results: In patients, the mean ALPS index ipsilateral to infarct was 1.162 ± 0.126, significantly lower (P < 0.001) than that of the contralateral side (1.335 ± 0.160). The right-to-left ALPS index ratio of patients with right cerebral infarct was 0.84 ± 0.08, significantly lower (P < 0.001) than that of normal subjects (0.95 ± 0.07). The left-to-right ALPS ratio of patients with left cerebral infarct was 0.92 ± 0.09, significantly (P < 0.001) lower than that of normal subjects (1.05 ± 0.08). On multiple linear regression analysis, time since stroke onset (β = 0.794, P < 0.001) was the only factor associated with the ALPS index.Conclusion: The ALPS index showed lower values in ischemic stroke suggesting impaired glymphatic function. Following initial impairment, the ALPS index increased with the time since stroke onset, which is suggestive of glymphatic function recovery.
format	article
author	Cheng Hong Toh Cheng Hong Toh Tiing Yee Siow
author_facet	Cheng Hong Toh Cheng Hong Toh Tiing Yee Siow
author_sort	Cheng Hong Toh
title	Glymphatic Dysfunction in Patients With Ischemic Stroke
title_short	Glymphatic Dysfunction in Patients With Ischemic Stroke
title_full	Glymphatic Dysfunction in Patients With Ischemic Stroke
title_fullStr	Glymphatic Dysfunction in Patients With Ischemic Stroke
title_full_unstemmed	Glymphatic Dysfunction in Patients With Ischemic Stroke
title_sort	glymphatic dysfunction in patients with ischemic stroke
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/1f14a69aeac64375bd7dc6da7107bfaa
work_keys_str_mv	AT chenghongtoh glymphaticdysfunctioninpatientswithischemicstroke AT chenghongtoh glymphaticdysfunctioninpatientswithischemicstroke AT tiingyeesiow glymphaticdysfunctioninpatientswithischemicstroke
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Glymphatic Dysfunction in Patients With Ischemic Stroke

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