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Brain involvement in patients with inflammatory bowel disease: a voxel-based morphometry and diffusion tensor imaging study

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Abstract

Objectives

To investigate structural brain changes in inflammatory bowel disease (IBD).

Methods

Brain magnetic resonance imaging (MRI) was performed on 18 IBD patients (aged 45.16 ± 14.71 years) and 20 aged-matched control subjects. The imaging protocol consisted of a sagittal-FLAIR, a T1-weighted high-resolution three-dimensional spoiled gradient-echo sequence, and a multisession spin-echo echo-planar diffusion-weighted sequence. Differences between patients and controls in brain volume and diffusion indices were evaluated using the voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) methods, respectively. The presence of white-matter hyperintensities (WMHIs) was evaluated on FLAIR images.

Results

VBM revealed decreased grey matter (GM) volume in patients in the fusiform and the inferior temporal gyrus bilaterally, the right precentral gyrus, the right supplementary motor area, the right middle frontal gyrus and the left superior parietal gyrus (p < 0.05). TBSS showed decreased axial diffusivity (AD) in the right corticospinal tract and the right superior longitudinal fasciculus in patients compared with controls. A larger number of WMHIs was observed in patients (p < 0.05).

Conclusions

Patients with IBD show an increase in WMHIs and GM atrophy, probably related to cerebral vasculitis and ischaemia. Decreased AD in major white matter tracts could be a secondary phenomenon, representing Wallerian degeneration.

Key Points

• There is evidence of central nervous system involvement in IBD.

• Diffusion tensor imaging detects microstructural brain abnormalities in IBD.

• Voxel based morphometry reveals brain atrophy in IBD.

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Abbreviations

IBD:

inflammatory bowel disease

UC:

ulcerative colitis

CD:

Crohn’s disease

CNS:

central nervous system

WMHIs:

white-matter hyperintensities

VBM:

voxel-based morphometry

GM:

grey matter

WM:

white matter

DTI:

diffusion tensor imaging

FA:

fractional anisotropy

MD:

mean diffusivity

RD:

radial diffusivity

AD:

axial diffusivity

TBSS:

tract-based spatial statistics

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Acknowledgments

The scientific guarantor of this publication is Dr. Maria I. Argyropoulou. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Loukas G. Astrakas) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece

    Anastasia K. Zikou, Loukas G. Astrakas, Loukia C. Tzarouchi & Maria I. Argyropoulou

  2. 1st Department of Internal Medicine (Hepato-Gastroenterology Unit), Medical School, University of Ioannina, Ioannina, Greece

    Maria Kosmidou & Epameinondas Tsianos

Authors
  1. Anastasia K. Zikou
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  2. Maria Kosmidou
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  3. Loukas G. Astrakas
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  4. Loukia C. Tzarouchi
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  6. Maria I. Argyropoulou
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Correspondence to Maria I. Argyropoulou.

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Zikou, A.K., Kosmidou, M., Astrakas, L.G. et al. Brain involvement in patients with inflammatory bowel disease: a voxel-based morphometry and diffusion tensor imaging study. Eur Radiol 24, 2499–2506 (2014). https://doi.org/10.1007/s00330-014-3242-6

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  • DOI: https://doi.org/10.1007/s00330-014-3242-6

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