Alterations of white matter integrity in patients with intracranial tuberculosis: A tract-based spatial statistics study

Abstract

Objective

Intracranial tuberculosis has high mortality and morbidity. Its physiopathologic mechanism, especially neurocognitive mechanism, remains unclear, and there are few studies on white matter in such patients. This study aimed to investigate the white matter abnormalities in patients with intracranial tuberculosis using tract-based spatial statistics (TBSS) method of diffusion tensor imaging (DTI).

Methods

Fifty patients with intracranial tuberculosis and 49 healthy controls (HCs) were included in this study. Differences in the fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) between patients and HCs were investigated using TBSS analysis. Partial correlation analysis was performed to explore correlations between DTI values and cognitive functions in patients with intracranial tuberculosis, with age and gender as covariates. Subgroup analysis was also conducted using the same method.

Results

Compared to HCs, patients with intracranial tuberculosis showed a widespread reduction of FA and increase of MD, RD and AD (P < 0.05, TFCE and FWE corrected). Notably, abnormalities in all four metrics were observed in 25 white matter tracts according to the Johns Hopkins University ICBM-DTI-81 White Matter Atlas. Patients with mixed intracranial tuberculosis (mixed-ITB) showed increased AD in a limited range compared with patients with tuberculous meningitis (TBM). With age and gender considered, the MD, RD and AD values in some regions significantly correlated with the cognitive assessment scores.

Conclusions

The results of this study indicated that patients with intracranial tuberculosis might have widespread abnormalities in the white matter of the brain, which might associate with their cognitive impairment.