Neuroradiology. 2025 May 29. doi: 10.1007/s00234-025-03654-6. Online ahead of print.
ABSTRACT
BACKGROUND: Thalassemia is an inherited hematological disorder characterized by chronic anemia and multisystem involvement, including potential impacts on the central nervous system. Research has suggested a relationship between thalassemia and glymphatic system dysfunction, which may contribute to neurocognitive impairments. However, the exact mechanisms linking thalassemia to changes in glymphatic function remain unclear.
OBJECTIVE: To investigate the relationship between glymphatic system function and thalassemia severity, particularly in patients with transfusion-dependent and non-transfusion-dependent thalassemia.
METHODS: The study included a population of 40 thalassemia patients (TM, n = 40) confirmed through genetic testing, consisting of 19 patients who were transfusion-dependent (TDT, n = 19) and 21 patients who were non-transfusion-dependent (NTDT, n = 21), along with 39 healthy controls (HC, n = 39) matched for age and sex. Glymphatic function was assessed using the index for diffusivity along the perivascular space (ALPS-index), with regions of interest selected from the medullary veins and crossing fibers in the lateral ventricles. Statistical analyses were performed using Analysis of Variance (ANOVA) for intergroup comparisons, supplemented by Bonferroni correction for multiple comparisons. Pearson correlation was utilized to explore the relationships between the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index and demographic factors, while multiple linear regression was employed to adjust for confounding variables. A significance threshold of P less than 0.05 was established for all statistical tests.
RESULTS: The mean DTI-ALPS Index for thalassemia patients were significantly lower than those of healthy controls, indicating impaired glymphatic function. No significant differences in DTI-ALPS Index were found between transfusion-dependent and non-transfusion-dependent groups. Correlation analysis showed minimal influence of age and education on glymphatic function in the study population.
CONCLUSION: This study demonstrates significant impairment in glymphatic system function in thalassemia patients, potentially related to chronic anemia and iron overload. These findings contribute to understanding the mechanisms underlying cognitive dysfunction in thalassemia.
PMID:40439942 | DOI:10.1007/s00234-025-03654-6
