Jie Fang ¹ Hongting Xu ² Yu Zhou ¹ Fan Zou ¹ Jiangle Zuo ² Jinmin Wu ¹ Qi Wu ¹ Qi X. Ming ² Haibao Wang ^1*

• ¹ Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
• ² Department of Nephrology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China

Introduction: Cognitive impairment in patients with end-stage renal disease (ESRD) is associated with brain structural damage. However, no prior studies have investigated the relationship between brain texture features and the cognitive function in ESRD patients. This study aimed to investigate changes in brain texture features in ESRD patients and their relationships with cognitive function using voxel-based 3D brain texture analysis (TA), and further predict individual cognitive-related brain damage in ESRD patients. Methods: Forty-seven ESRD patients and 45 control subjects underwent whole-brain high-resolution 3D T1-weighted imaging scans and neuropsychological assessments. The voxel-based 3D brain TA was performed to examine inter-group differences in brain texture features. Additionally, within the ESRD group, the relationships of altered texture features with neuropsychological function and clinical indicators were analyzed. Finally, receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of brain texture features for cognitive-related brain damage in ESRD patients. Results: Compared to the control group, the ESRD group exhibited altered texture features in several brain regions, including the insula, temporal lobe, striatum, cerebellum, and fusiform gyrus (p < 0.05, Gaussian random-field correction). Some of these altered texture features were associated with scores from the Digit Symbol Substitution Test and the Trail Making Test Parts A (p < 0.05), and showed significant correlations with serum creatinine and calcium levels within the ESRD group (p < 0.05). Notably, ROC curve analysis revealed that the texture features in the right insula and left middle temporal gyrus could accurately predict cognitive-related brain damage in ESRD patients, with the area under the curve values exceeding 0.90. Conclusion: Aberrant brain texture features may be involved in the neuropathological mechanism of cognitive decline, and have high accuracy in predicting cognitive-related brain damage in ESRD patients. TA offers a novel neuroimaging marker to explore the neuropathological mechanisms of cognitive impairment in ESRD patients, and may be a valuable tool to predict cognitive decline.