Three-dimensional Pseudo-continuous Arterial Spin Labeling Technique to Assess Cerebral Perfusion Changes in End-stage Renal Disease Patients Undergoing Hemodialysis.

Objective: This study aimed to investigate cerebral blood flow (CBF) alterations in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis and to evaluate its potential association with cognitive dysfunction. The findings are expected to provide neuroimaging evidence for early clinical screening and intervention.

Methods: A total of 40 ESRD patients undergoing maintenance hemodialysis and 40 healthy individuals were recruited. All participants underwent the Montreal Cognitive Assessment (MoCA), conventional brain MRI, and three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL). Neuropsychological test scores, hemoglobin levels, and 3D-pCASL imaging data were collected. After image preprocessing, regions showing statistically significant differences in CBF between the ESRD and control groups were identified. Correlation analysis was conducted between CBF values in brain regions with statistical differences in both hemispheres of ESRD hemodialysis patients and MoCA scores and hemoglobin levels.

Results: ESRD patients undergoing maintenance hemodialysis exhibited significantly lower MoCA scores compared to healthy controls (23.5 vs. 27, P < 0.001). Furthermore, CBF analysis revealed significantly increased perfusion in multiple brain regions in the ESRD group compared to the control group, predominantly in the default mode network (DMN) and bilateral cerebellum (Corrected by voxel-level Gaussian random field (GRF) criterion and set P < 0.001; cluster-level (two-tailed) GRF criterion and set P < 0.05). In ESRD patients, CBF values showed significant positive correlations with MoCA scores in the following regions: left dorsolateral prefrontal cortex (P = 0.01, r = 0.40), left precentral gyrus (P = 0.01, r = 0.39), right precentral gyrus (P = 0.02, r = 0.36), left medial superior frontal gyrus (P = 0.01, r = 0.40), and right medial superior frontal gyrus (P = 0.004, r = 0.44). No significant correlations were observed between CBF and age. Additionally, there were no brain regions in which CBF values were significantly associated with hemoglobin levels.

Conclusions: Significant cerebral perfusion abnormalities were observed in ESRD patients undergoing maintenance hemodialysis, primarily affecting the DMN and bilateral cerebellum, which may be closely related to cognitive dysfunction. These findings suggest potential neuroimaging biomarkers for the early identification of cognitive impairment in ESRD patients and provide a scientific basis for future clinical diagnosis and therapeutic interventions.