ArticleEuropean journal of radiology open2025
Glymphatic dysfunction as an imaging biomarker for cognitive impairment in patients with β-thalassemia major: A multimodal MRI study.
Article in European journal of radiology open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and purpose: Cerebral lymphatic abnormalities have been associated with neurodegenerative processes. However, brain glymphatic system and its role in cognitive impairment in β-thalassemia major (β-TM) remain unknown. This study assessed brain glymphatic alterations in β-TM using advanced neuroimaging and their correlation with cognitive deficits. Method: Thirty-five β-TM patients and forty matched healthy controls (HC) underwent standardized cognitive assessment and diffusion tensor imaging (DTI). Automated segmentation derived glymphatic parameters: Analysis Along the Perivascular Space index (DTI-ALPS index), choroid plexus volume fraction (CPVF), perivascular space volume fraction (PVSVF), and fractional volume of free water in white matter (FW-WM) and were compared between groups. Correlations with cognitive scores were analyzed. Result: Compared with the HC, β-TM patients showed significantly lower DTI-ALPS index values in the left hemisphere (1.4527vs1.5275,P = 0.003), the right hemisphere (1.3648vs1.4492,P = 0.004) and bilateral hemispheres (1.4087vs1.4884,P = 0.001), alongside higher CPVF values in the left hemisphere (0.5426vs0.4655,P = 0.034), the right hemisphere (0.5296vs0.4439,P = 0.018) and bilateral hemispheres (1.0731vs0.9095,P = 0.01). The patient group also had higher PVSVF values in the white matter (0.2848vs0.2488,P = 0.841), the subcortical regions (0.1718vs0.1470,P = 0.349) and whole brain (0.4566vs0.3958,P = 0.678), and had higher FW-WM value (0.1580vs0.1557,P = 0.384). Lower DTI-ALPS index and higher FW-WM value was associated with poorer cognitive performance in the β-TM patients (P < 0.05). Conclusions: The DTI-ALPS index is a potential neuroimaging biomarker for glymphatic dysfunction and cognitive impairment in β-TM. Increased CP volume implicated underlying glymphatic alterations, supporting integration of glymphatic MRI metrics into clinical cognitive assessment for this population.
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