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Indian J Radiol Imaging. 2019 Oct-Dec;29(4):356-363. doi: 10.4103/ijri.IJRI_326_19. Epub 2019 Dec 31.

Evaluation of cerebral microstructural changes in adult patients with obstructive sleep apnea by MR diffusion kurtosis imaging using a whole-brain atlas.

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Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiology, University of Miami, Miami, Florida, USA.
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.



The association between obstructive sleep apnea (OSA) and cognitive impairment is well-recognized, but little is known about neural derangements that underlie this phenomenon. The purpose of this study was to evaluate the utility of diffusion kurtosis imaging (DKI) using a whole-brain atlas to comprehensively assess microstructural tissue changes in the brain of patients with OSA.


This prospective study was conducted in 20 patients with moderate-to-severe OSA and 20 age- and gender-matched controls. MRI data acquisition was performed with 3 Tesla and data was analyzed using a whole-brain atlas. DKI data were processed and transformed into a brain template space to obtain various kurtosis parameters including axial kurtosis (AK), radial kurtosis (RK), mean kurtosis (MK), and kurtosis fractional anisotropy (KFA) using a 189-region brain atlas in the same template space. These kurtosis measurements were further analyzed using a student t-test in order to determine kurtosis measurements that present significant differences between the OSA patient set and the control set.


Significant differences (P < 0.05) were found in AK (54 regions), RK (10 regions), MK (6 regions) and KFA (41 regions) values in patients with OSA as compared to controls. DKI indices, using an atlas-based whole-brain analysis approach used in our study, showed widespread involvement of the anatomical regions in patients with OSA.


The kurtosis parameters are more sensitive in demonstrating abnormalities in brain tissue structural organization at the microstructural level before any detectable changes appear in conventional MRI or other imaging modalities.


Kurtosis imaging; MRI; obstructive sleep apnea

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