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Clinical Trial
. 2021 Mar 15;12(3):278-291.
doi: 10.4239/wjd.v12.i3.278.

Altered spontaneous brain activity in patients with diabetic optic neuropathy: A resting-state functional magnetic resonance imaging study using regional homogeneity

Gui-Ying Guo  1 , Li-Juan Zhang  1 , Biao Li  1 , Rong-Bin Liang  1 , Qian-Min Ge  1 , Hui-Ye Shu  1 , Qiu-Yu Li  1 , Yi-Cong Pan  1 , Chong-Gang Pei  1 , Yi Shao  2
Affiliations
Clinical Trial

Altered spontaneous brain activity in patients with diabetic optic neuropathy: A resting-state functional magnetic resonance imaging study using regional homogeneity

Gui-Ying Guo et al. World J Diabetes. .

Abstract

Background: Diabetes is a common chronic disease. Given the increasing incidence of diabetes, more individuals are affected by diabetic optic neuropathy (DON), which results in decreased vision. Whether DON leads to abnormalities of other visual systems, including the eye, the visual cortex, and other brain regions, remains unknown.

Aim: To investigate the local characteristics of spontaneous brain activity using regional homogeneity (ReHo) in patients with DON.

Methods: We matched 22 patients with DON with 22 healthy controls (HCs). All subjects underwent resting-state functional magnetic resonance imaging. The ReHo technique was used to record spontaneous changes in brain activity. Receiver operating characteristic (ROC) curves were applied to differentiate between ReHo values for patients with DON and HCs. We also assessed the correlation between Hospital Anxiety and Depression Scale scores and ReHo values in DON patients using Pearson correlation analysis.

Results: ReHo values of the right middle frontal gyrus (RMFG), left anterior cingulate (LAC), and superior frontal gyrus (SFG)/left frontal superior orbital gyrus (LFSO) were significantly lower in DON patients compared to HCs. Among these, the greatest difference was observed in the RMFG. The result of the ROC curves suggest that ReHo values in altered brain regions may help diagnose DON, and the RMFG and LAC ReHo values are more clinically relevant than SFG/LFSO. We also found that anxiety and depression scores of the DON group were extremely negatively correlated with the LAC ReHo values (r = -0.9336, P < 0.0001 and r = -0.8453, P < 0.0001, respectively).

Conclusion: Three different brain regions show ReHo changes in DON patients, and these changes could serve as diagnostic and/or prognostic biomarkers to further guide the prevention and treatment of DON patients.

Keywords: Brain activity; Diabetes; Diabetic optic neuropathy; Functional magnetic resonance imaging; Regional homogeneity; Resting state.

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Conflict of interest statement

Conflict-of-interest statement: This is not an industry supported study. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Typical example of diabetic optic neuropathy seen on fundus camera and fluorescence fundus angiography. A: Fundus camera; B: Fluorescence fundus angiography.
Figure 2
Figure 2
Spontaneous brain activity in patients with diabetic optic neuropathy. Blue regions (right middle frontal gyrus, left anterior cingulate, and superior frontal gyrus/left frontal superior orbital gyrus) indicate lower regional homogeneity values (z > 2.3, P < 0.05, cluster size, > 40, AlphaSim-corrected). R: Right; L: Left.
Figure 3
Figure 3
Means of altered regional homogeneity between the diabetic optic neuropathy group and healthy controls. ReHo: Regional homogeneity; DON: Diabetic optic neuropathy; HC: Healthy control; RMFG: Right middle frontal gyrus; LAC: Left anterior cingulate; SFG: Superior frontal gyrus; LFSO: Left frontal superior orbital gyrus.
Figure 4
Figure 4
Receiver operating characteristic curve analysis of the mean regional homogeneity values for altered brain regions. The area under the receiver operating characteristic curve was 0.984, (P < 0.001; 95%CI: 0.945-1.000) for the right middle frontal gyrus; 0.984 (P < 0.001; 95%CI: 0.948-1.000) for the left anterior cingulate; and 0.929 (P < 0.001; 95%CI: 0.832-1.000) for the superior frontal gyrus/left frontal superior orbital gyrus. ROC: Receiver operating characteristic; RMFG: Right middle frontal gyrus; LAC: Left anterior cingulate; SFG: Superior frontal gyrus; LFSO: Left frontal superior orbital gyrus; AUC: Area under the ROC curve.
Figure 5
Figure 5
Correlations between the mean regional homogeneity values of the left anterior cingulate and the clinical behaviors. A: The anxiety scores showed a negative correlation with the regional homogeneity (ReHo) values of the left anterior cingulate (LAC) (r = −0.9336, P < 0.001); B: The depression scores showed a negative correlation with the ReHo values of the LAC (r = −0.8453, P < 0.001). ReHo: Regional homogeneity; AS: Anxiety scores; DS: Depression scores.
Figure 6
Figure 6
Regional homogeneity results of brain activity in the diabetic optic neuropathy group. Compared with the healthy controls, the regional homogeneity values of regions 1-3 in diabetic optic neuropathy patients were decreased to various extents; region 1 refers to the superior frontal gyrus/left frontal superior orbital gyrus [Brodmann area (BA) 48; t = 4.0066], region 2 to the right middle frontal gyrus (BA 45; t = 4.4606), and region 3 to the left anterior cingulate (BA 32; t = 4.6582). ReHo: Regional homogeneity; 1: Superior frontal gyrus/left frontal superior orbital gyrus; 2: Right middle frontal gyrus; 3: Left anterior cingulate.
Figure 7
Figure 7
Relationship between regional homogeneity values of the left anterior cingulate and emotional state. Compared with healthy controls, the regional homogeneity values of the left anterior cingulate were decreased and diabetic optic neuropathy patients are more likely to have anxiety and depression.
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