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Altered Brain Microstructure Assessed by Diffusion Tensor Imaging in Patients With Diabetes Mellitus and Gastrointestinal Symptoms

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  • Jens Brøndum Frøkjær, Danmark
  • Lars Wiuff Andersen
  • ,
  • Christina Brock
  • Magnus Simrén
  • ,
  • Maria Ljungberg
  • ,
  • Eirik Søfteland
  • ,
  • Georg Dimcevski
  • ,
  • Yousef Yavarian, Danmark
  • Hans Gregersen, Danmark
  • Asbjørn Mohr Drewes
OBJECTIVEIn patients with long-standing diabetes mellitus (DM), there is increasing evidence for abnormal processing of gastrointestinal sensations in the central nervous system. Using magnetic resonance diffusion tensor imaging, we characterized brain microstructure in areas involved in visceral sensory processing and correlated these findings to clinical parameters.RESEARCH DESIGN AND METHODSTwenty-six patients with DM and gastrointestinal symptoms and 23 healthy control subjects were studied in a 3T scanner. The apparent diffusion coefficient (i.e., diffusivity of water) and fractional anisotropy (FA) (i.e., organization of fibers) were assessed in the "sensory matrix" (cingulate cortex, insula, prefrontal and secondary sensory cortex, amygdala, and corona radiata) and in corpus callosum.RESULTSPatients had decreased FA values compared with control subjects: 1) all areas (P = 0.025); 2) anterior (P <0.001), mid- (P = 0.001), and posterior (P <0.001) cingulate cortex; 3) prefrontal cortex gray matter (P <0.001); 4) corona radiata (P <0.001); 5) secondary sensory cortex (P = 0.008); 6) anterior white matter (P = 0.045); and anterior gray matter (P = 0.002) and posterior gray matter (P = 0.002) insula. No difference was found in corpus callosum (P > 0.05). The microstructural changes were for some areas correlated to clinical parameters such as bloating (anterior insula), mental well-being (anterior insula, prefrontal cortex, and mid-cingulated and corona radiata), autonomic function based on electrocardiographic results (posterior insula and anterior cingulate), and presence of gastroparesis (anterior insula).CONCLUSIONSThe findings of this explorative study indicate that microstructural changes of brain areas involved in visceral sensory processing are associated with autonomic dysfunction and therefore may be involved in the pathogenesis of gastrointestinal symptoms in DM patients.
TidsskriftDiabetes Care
StatusE-pub ahead of print - 2012

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