Clinical study of hypertension-related brain volume and white matter hyperintensity changes based on multimodal MRI
Objective:The volume and white matter hyperintensities (WMH) in the brain were studied,based on voxel-based morphometry (VBM) and semi-quantitative assessment of WMH in hypertensive patients. Materials and Methods:This retrospective study included confirmed hypertensive cases and healthy control cases from Suzhou Science and Technology City Hospital Affiliated to Nanjing University from January 2018 to November 2022. All enrolled cases underwent thin layers T1WI sequence examination. Firstly,images were imported into the brain structure EKM-KELM+classification algorithm model to calculate gray matter volume (GMV),white matter volume (WMV) and total intracranial volume (TIV). The gray and white matter volume of each brain region was expressed as the ratio of GMV/TIV and WMV/TIV,respectively,to analyze the variation characteristics of brain gray matter volume in hypertensive patients of different ages. At the same time,Scheltens Visual Quantitative Assessment of WMH was performed on fluid attenuated inversion recovery (FLAIR) images. Results:(1) A total of 509 cases were included in this study,including 91 cases in the normal blood pressure group and 418 cases in the hypertension group. Among them,136 cases were young (20-40 years old),218 cases were middle-aged (41-60 years old) and 155 cases were elderly (61-80 years old). There were no significant differences in gender and age within groups (all P>0.05). (2) There were significant differences among hypertension grades in GMV/TIV of the left olfactory cortex (P=0.031),left straight gyrus (P=0.036),right straight gyrus (P=0.022),and right inferior occipital gyrus (P=0.011) in young patients. (3) The comparison of GMV/TIV in the middle-aged group showed that there was significant difference in the volume of the left supplementary motor area among different hypertension levels (P=0.036),while there was no significant difference in WMV/TIV. (4) GMV/TIV comparison showed that there was significant difference in right olfactoid cortex volume among different hypertension grades (P=0.047),while there was no significant difference in WMV/TIV. (5) Scheltens visual score showed that there was no significant difference in the young group (P>0.05). In the middle age group,there were statistically significant differences in the high signal of voidural quality (frontal angle,occipital angle and lateral ventricle) (P=0.028,0.032,0.020),and statistically significant differences in deep white matter (frontal lobe) (P=0.024). There was significant difference in the frontal Angle,frontal lobe and pallidum WMH in the old group (P=0.022,0.024,0.015). Conclusions:Multi modal semi-quantitative analysis of MRI can effectively evaluate changes in BVM and WMH in hypertensive patients.With the increase of blood pressure level,the gray matter volume of the young group changed more than that of the middle and old group. WMH was more likely to appear in the middle-aged group than in the young group.
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