{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:03:57Z","timestamp":1784570637018,"version":"3.55.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Scientific Research Program of Wuxi Health Commission","award":["M202326"],"award-info":[{"award-number":["M202326"]}]},{"name":"Yixing Taodu Zhiguang Technology Research Project","award":["2023SF20"],"award-info":[{"award-number":["2023SF20"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study investigated the properties of strip-shaped white matter hyperintensities (WMHs) by examining the relationship between their principal axes and maximum diffusion direction, and comparing their diffusion tensor metrics with punctate and early confluent WMHs to explore their pathological features and potential link to chronic axonal injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighty-seven participants with isolated WMHs were included and received diffusion tensor imaging (DTI) using a 3.0-T MR scanner. Lesions were classified by elongation (strip-shaped:\u2009\u2265\u20092; punctate:\u2009&lt;\u20092). We recorded the maximum diffusion direction of punctate, strip-shaped, and early confluent WMHs and evaluated their consistency with the principal axial direction. Additionally, the diffusion tensor metrics of strip-shaped WMHs were measured and compared with those of punctate and early confluent WMHs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 996 WMHs, 57.5% of strip-shaped lesions showed principal axis alignment with the maximum diffusion direction, significantly higher than punctate (44.7%) and early confluent (42.1%) lesions (P\u2009&lt;\u20090.05). Mixed-effects models showed significant lesion type effects on FA, MD, AD, and RD (all P\u2009&lt;\u20090.05). Post-hoc comparisons revealed that stripe lesions had higher FA but lower MD and RD than confluence lesions (all P\u2009&lt;\u20090.05), with no significant differences between stripe and punctate groups for MD or RD. No AD differences were found among groups. Fiber tracking confirmed alignment in most strip-shaped lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Strip-shaped WMHs exhibit unique diffusion metrics and fiber alignment, suggesting chronic axonal injury due to neurodegeneration. These findings underscore the importance of morphological and microstructural analysis in understanding WMH heterogeneity and clinical significance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354301","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:29:56Z","timestamp":1784568596000},"page":"e0354301","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The strip-shaped deep white matter hyperintensities may be related to neurodegeneration: A study based on diffusion tensor imaging"],"prefix":"10.1371","volume":"21","author":[{"given":"Xuexia","family":"Sheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghua","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daihai","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenchao","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyuan","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyue","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4354-2139","authenticated-orcid":true,"given":"Zhigang","family":"Min","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"issue":"8","key":"pone.0354301.ref001","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S1474-4422(13)70124-8","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"JM Wardlaw","year":"2013","journal-title":"Lancet Neurol"},{"issue":"7","key":"pone.0354301.ref002","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/S1474-4422(23)00131-X","article-title":"Neuroimaging standards for research into small vessel disease-advances since 2013","volume":"22","author":"M Duering","year":"2023","journal-title":"Lancet Neurol"},{"issue":"2","key":"pone.0354301.ref003","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2214\/ajr.149.2.351","article-title":"MR signal abnormalities at 1.5 T in Alzheimer\u2019s dementia and normal aging","volume":"149","author":"F Fazekas","year":"1987","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"pone.0354301.ref004","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/1531-8249(200002)47:2<145::AID-ANA3>3.0.CO;2-P","article-title":"Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study","volume":"47","author":"JC de Groot","year":"2000","journal-title":"Ann Neurol"},{"key":"pone.0354301.ref005","first-page":"10","article-title":"Impact of cerebral white matter changes on functionality in older adults: An overview of the LADIS Study results and future directions","author":"LADIS Study Group","year":"2015","journal-title":"Geriatr Gerontol Int"},{"issue":"12","key":"pone.0354301.ref006","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.3390\/brainsci12121674","article-title":"Heterogeneity of white matter hyperintensity and cognitive impairment in patients with acute lacunar stroke","volume":"12","author":"M Ye","year":"2022","journal-title":"Brain Sci"},{"issue":"3","key":"pone.0354301.ref007","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1038\/nrneurol.2015.10","article-title":"White matter hyperintensities, cognitive impairment and dementia: an update","volume":"11","author":"ND Prins","year":"2015","journal-title":"Nat Rev Neurol"},{"issue":"8","key":"pone.0354301.ref008","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1042\/CS20160452","article-title":"Lesion location and cognitive impact of cerebral small vessel disease","volume":"131","author":"JM Biesbroek","year":"2017","journal-title":"Clin Sci (Lond)"},{"key":"pone.0354301.ref009","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.trci.2019.02.001","article-title":"White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities","volume":"5","author":"J Alber","year":"2019","journal-title":"Alzheimers Dement (N Y)"},{"issue":"12","key":"pone.0354301.ref010","doi-asserted-by":"crossref","first-page":"5632","DOI":"10.1002\/alz.13345","article-title":"White matter hyperintensity shape is associated with long-term dementia risk","volume":"19","author":"JA Keller","year":"2023","journal-title":"Alzheimers Dement"},{"issue":"4","key":"pone.0354301.ref011","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.biopsych.2008.03.024","article-title":"Classification of white matter lesions on magnetic resonance imaging in elderly persons","volume":"64","author":"KW Kim","year":"2008","journal-title":"Biol Psychiatry"},{"issue":"17","key":"pone.0354301.ref012","article-title":"Association of White matter hyperintensity markers on MRI and long-term risk of mortality and ischemic stroke: the SMART-MR Study","volume":"96","author":"UCC-Smart Study Group","year":"2021","journal-title":"Neurology"},{"key":"pone.0354301.ref013","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.neurobiolaging.2022.08.009","article-title":"White matter hyperintensity shape is associated with cognitive functioning - the SMART-MR study","volume":"120","author":"MHT Zwartbol","year":"2022","journal-title":"Neurobiol Aging"},{"issue":"1","key":"pone.0354301.ref014","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1038\/s41598-018-20084-y","article-title":"White matter hyperintensity shape and location feature analysis on brain MRI; proof of principle study in patients with diabetes","volume":"8","author":"J de Bresser","year":"2018","journal-title":"Sci Rep"},{"issue":"5","key":"pone.0354301.ref015","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1161\/STROKEAHA.117.020495","article-title":"Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging","volume":"49","author":"CMJ Loos","year":"2018","journal-title":"Stroke"},{"issue":"9","key":"pone.0354301.ref016","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1212\/WNL.43.9.1683","article-title":"Pathologic correlates of incidental MRI white matter signal hyperintensities","volume":"43","author":"F Fazekas","year":"1993","journal-title":"Neurology"},{"issue":"7","key":"pone.0354301.ref017","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/S1474-4422(19)30079-1","article-title":"Small vessel disease: mechanisms and clinical implications","volume":"18","author":"JM Wardlaw","year":"2019","journal-title":"Lancet Neurol"},{"issue":"1","key":"pone.0354301.ref018","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13195-025-01707-9","article-title":"Perivascular space and white matter hyperintensities in Alzheimer\u2019s disease: associations with disease progression and cognitive function","volume":"17","author":"PM Schirge","year":"2025","journal-title":"Alzheimers Res Ther"},{"key":"pone.0354301.ref019","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.2147\/NSS.S496607","article-title":"Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) demonstrates that sleep disorders exacerbate glymphatic circulatory impairment and cognitive impairment in patients with Alzheimer\u2019s disease","volume":"16","author":"Y Shang","year":"2024","journal-title":"Nat Sci Sleep"},{"key":"pone.0354301.ref020","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1002\/nbm.782","article-title":"The basis of anisotropic water diffusion in the nervous system - a technical review","volume":"15","author":"C Beaulieu","year":"2002","journal-title":"NMR Biomed"},{"issue":"1","key":"pone.0354301.ref021","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12883-021-02140-9","article-title":"Diffusion tensor imaging revealed different pathological processes of white matter hyperintensities","volume":"21","author":"Z-G Min","year":"2021","journal-title":"BMC Neurol"},{"issue":"2","key":"pone.0354301.ref022","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.cmpb.2005.08.004","article-title":"DtiStudio: resource program for diffusion tensor computation and fiber bundle tracking","volume":"81","author":"H Jiang","year":"2006","journal-title":"Comput Methods Programs Biomed"},{"issue":"7","key":"pone.0354301.ref023","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1038\/nmeth.2019","article-title":"Fiji: an open-source platform for biological-image analysis","volume":"9","author":"J Schindelin","year":"2012","journal-title":"Nat Methods"},{"issue":"14","key":"pone.0354301.ref024","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1093\/bioinformatics\/btt276","article-title":"TANGO: a generic tool for high-throughput 3D image analysis for studying nuclear organization","volume":"29","author":"J Ollion","year":"2013","journal-title":"Bioinformatics"},{"key":"pone.0354301.ref025","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3389\/fninf.2012.00023","article-title":"Automated regional behavioral analysis for human brain images","volume":"6","author":"JL Lancaster","year":"2012","journal-title":"Front Neuroinform"},{"key":"pone.0354301.ref026","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.neuroimage.2012.06.081","article-title":"White matter integrity, fiber count, and other fallacies: the do\u2019s and don\u2019ts of diffusion MRI","volume":"73","author":"DK Jones","year":"2013","journal-title":"Neuroimage"},{"issue":"2","key":"pone.0354301.ref027","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.neuroimage.2009.04.066","article-title":"A longitudinal diffusion tensor imaging study on Wallerian degeneration of corticospinal tract after motor pathway stroke","volume":"47","author":"C Yu","year":"2009","journal-title":"Neuroimage"},{"issue":"1","key":"pone.0354301.ref028","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12883-018-1069-5","article-title":"Axonal chronic injury in treatment-na\u00efve HIV+ adults with asymptomatic neurocognitive impairment and its relationship with clinical variables and cognitive status","volume":"18","author":"R-L Li","year":"2018","journal-title":"BMC Neurol"},{"issue":"5","key":"pone.0354301.ref029","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00234-018-2012-6","article-title":"Beyond fractional anisotropy in amyotrophic lateral sclerosis: the value of mean, axial, and radial diffusivity and its correlation with electrophysiological conductivity changes","volume":"60","author":"AF Geraldo","year":"2018","journal-title":"Neuroradiology"},{"issue":"3","key":"pone.0354301.ref030","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1006\/nimg.2002.1267","article-title":"Dysmyelination revealed through MRI as increased radial (but unchanged axial) diffusion of water","volume":"17","author":"S-K Song","year":"2002","journal-title":"Neuroimage"},{"key":"pone.0354301.ref031","doi-asserted-by":"crossref","first-page":"92","DOI":"10.3389\/fneur.2018.00092","article-title":"Understanding the physiopathology behind axial and radial diffusivity changes-what do we know?","volume":"9","author":"PJ Winklewski","year":"2018","journal-title":"Front Neurol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354301","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:30:00Z","timestamp":1784568600000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354301"}},"subtitle":[],"editor":[{"given":"Ioannis","family":"Liampas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354301","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}