Objective: To describe the imaging abnormalities affecting striatopallidal regions (SP; caudate, putamen, and globus pallidum) in people with diabetes mellitus (DM).

Background: DM can lead to imaging abnormalities in the SP, which have been described within the spectrum of diabetic striatopathy. These findings include striatal hyperdensity on CT, T1 hyperintensity or T2 hypointensity on MRI, as well as other abnormalities involving the SP. Here, we present a retrospective study of imaging abnormalities affecting the SP in people with DM.

Method: We conducted a review of medical records of people with DM who had a brain CT and MRI at the University of Rochester Medical Center between 2018 and 2020. We analyzed images of the SP. Qualitative analysis included visual examination of 1) CT density (normal, hypodense or hyperdense) and 2) MRI T1 and T2 intensities (normal, hypointense or hyperintense). Quantitative CT analysis was conducted by measuring the density of the caudate and lentiform nuclei bilaterally in Hounsfield units (HU). We then calculated the average HU SP score. ANOVA, Pearson correlation, and Fisher’s exact test were used for the statistical analyses.

Results: We reviewed 508 charts and 200 met the inclusion criteria. Qualitative imaging analysis of the SP was considered normal in 181 subjects (90.5%) and abnormal in 19 (9.5%). Seven (3.5%) had CT abnormalities (5 in the pallidum, 2 in the striatum) and 12 (6%) had MRI abnormalities (10 in the pallidum, 2 in the striatum). The average HU SP score was not significantly different between those with normal and abnormal CT (34.3±2.6 vs 35.0±2.7; p=0.549). Subjects with abnormal MRI were significantly older than those with normal imaging (75.2±13.0 vs 63.9±12.7; p=0.009). Asian race was associated with imaging abnormalities (p=0.028). The average HU SP score was not significantly associated with age, sex or race.

Conclusion: We found imaging abnormalities affecting the SP in 9.5% of people with DM, which is higher than the 0.16% estimated prevalence of diabetic striatopathy. Pallidal calcifications may have contributed to more abnormalities observed in the pallidum than in the striatum. Since DM affects the striatum more commonly, including the pallidum might have been a confounding factor contributing to the average HU SP scores being similar. Future studies could separate the abnormalities affecting striatal and pallidal regions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuroimaging-abnormalities-of-the-striatopallidal-regions-in-people-with-diabetes-a-single-center-retrospective-study/