Iron Deficiency Anemia is associated with extensive white matter damage: A diffusion kurtosis analysis

Motivation: Women with iron deficiency anemia (IDA) experience significant neurocognitive and motor deficits, which could result from white matter (WM) damage. Goal(s): To examine WM changes on diffusion MRI caused by IDA. Approach: We quantified the diffusion kurtosis tensor in 35 female IDA patients and 19 healthy controls. Then, we performed a voxel-wise analysis controlling for blood markers of anemia. Results: Increased radial and mean kurtosis was observed in the entire WM, well beyond watershed areas impacted by ischemic processes, suggesting diffusely impaired myelin maintenance. Our findings suggest that IDA impacts WM health through factors beyond hypoxia alone. Impact: In iron deficiency anemia, Kurtosis imaging showed significant differences in WM with respect to controls; not linked to the anemia severity but consistent with demyelination processes. Our findings highlight the importance of timely diagnosis and treatment to prevent WM degeneration.