---
title: "Exploring Strip-Shaped White Matter Hyperintensities and Their Link to Neurodegeneration Using DTI"
id: "plos-one-0-the-strip-shaped-deep-white-matter-hyperintensities-may-be-related-to"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-0-the-strip-shaped-deep-white-matter-hyperintensities-may-be-related-to"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0354301"
published_at: "2026-07-20T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Exploring Strip-Shaped White Matter Hyperintensities and Their Link to Neurodegeneration Using DTI
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-0-the-strip-shaped-deep-white-matter-hyperintensities-may-be-related-to
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0354301)
- **Published At:** 2026-07-20T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This study investigates the relationship between **strip-shaped white matter hyperintensities (WMHs)** and **neurodegeneration**. - Participants included 87 individuals with isolated WMHs analyzed via **diffusion tensor imaging (DTI)** using a 3.0-T MR scanner. - Strip-shaped lesions (elongation ≥2) had a higher alignment with the maximum diffusion direction compared to punctate and early confluent lesions. - Significant differences in diffusion metrics (FA, MD, AD, RD) were observed across lesion types, suggesting unique **pathological features** of strip-shaped WMHs. - Results indicate that strip-shaped WMHs may represent chronic axonal injury linked to neurodegenerative processes, underlining the importance of morphological and microstructural analysis of WMH heterogeneity.
## Clinical Analysis & Structured Key Points
SKIP TO MAIN CONTENT Advertisement plos.org Create account Sign in About Browse Publish advanced search 0 Save 0 Citation 25 View 0 Share OPEN ACCESS PEER-REVIEWED RESEARCH ARTICLE The strip-shaped deep white matter hyperintensities may be related to neurodegeneration: A study based on diffusion tensor imaging Xuexia Sheng, Long Xu, Donghua Xu, Daihai Yuan, Wenchao Xie, Jiyuan Ge, Yizhi Zhao, Chaoyue Yang, Zhigang Min Published: July 20, 2026 https://doi.org/10.1371/journal.pone.0354301 Article Authors Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Conclusions References Reader Comments Figures Abstract Purpose 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. Methods 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: ≥ 2; punctate: 3%. Maps of fractional anisotropy (FA), mean diffusivity (MD), AD, and RD were calculated. Measurements The “magic wands” tool in DTIStudio [22] was used on B0 images to define 3D regions of interest (ROIs) for each lesion. Two experienced neuroradiologists (Yuan D and Min Z) used FLAIR sequences to distinguish WMHs from perivascular spaces or lacunes, resolving disagreements through consensus. Lesion locations were recorded based on colored FA map, and their direction of the maximum eigenvector (x, y and z representing left-right, anterior-posterior, and cephalo-caudal directions, respectively) were determined. Mean FA, MD, AD, and RD values were measured. ROIs were saved and converted to Analyze format using the ROIEditor. Lesions volume, major radius, and elongation were measured using Fiji’s 3D suite [23]. Since the morphology of lesions in 3D may differ from that in 2D, we used the elongation value to reclassify the extracted lesions. WMHs were classified as strip-shaped if elongation was ≥ 2 and punctate if 0.05). The random effect of participant was not significant for any of the four metrics (P = 0.430, 0.122, 0.671, and 0.112, respectively). Download: PNG larger image TIFF original image Table 3. Compare measurements adjusted with age and lesion volume among punctate lesions (Elongation<2), strip-shaped lesions (Elongation≥2), and early confluent lesions. https://doi.org/10.1371/journal.pone.0354301.t003 Discussion Our findings indicate 57.5% of strip-shaped WMHs have principal axes consistent with the direction of white matter fibers, a proportion significantly higher than that of punctate and early confluent WMHs. Additionally, significant differences in diffusion tensor metrics suggest that strip-shaped WMHs have distinct pathological features compared to punctate and early confluent WMHs. Fiber tracing revealed that some strip-shaped WMHs with inconsistent principal axes and maximum diffusivity directions still had fibers following their principal axes, possibly due to crossed fiber bundles masking the maximum eigenvalue direction [26]. The alignment of principal axes with fiber progression in most strip-shaped WMHs suggests a neurodegenerative origin, a spatial relationship not expected for randomly distributed perivascular or interstitial pathologies [17,18]. Strip-shaped WMH exhibited lower RD than early confluent WMHs. Although not statistically significant, there was a trend toward higher AD in the stripe-shaped group compared to the punctate group. The increased AD in strip-shaped WMHs contrasts with the decreased AD observed in early Wallerian degeneration [27], suggesting chronic axonal injury secondary to axons or astrocytic process loss. Similar changes have been observed in neurodegenerative diseases such as HIV [28], ALS [29], and Alzheimer’s disease [29]. The higher RD in early confluent WMHs is consistent with severe demyelination [30,31], supporting previous findings [9]. However, the lack of significant RD differences between strip-shaped and punctate WMHs suggest distinct pathological mechanisms. Of course, further pathological studies are paramount to corroborate this inference. It should also be noted that alterations in AD and RD could be confounded by shifts in water content, and their definitive relationship with neurodegeneration versus demyelination has yet to be fully established [31]. We employed a mixed-effects model incorporating participants as random effects, indicating that the findings from our lesion-level analysis were not driven by subject-level variability. This study has several limitations. First, the use of an elongation threshold of 2 to
## Related Clinical Research

- [High-dose vitamin D (≥5,000 IU) linked to better cognition in older adults with MCI and sleep prob](https://medichelpline.com/clinical-feed/medical-news-today-1-high-dose-vitamin-d-may-boost-brain-heath-in-older-adults-at-risk-of-dementia.md)
- [Leisure physical activity lowers dementia risk while occupational activity may raise it, review fi](https://medichelpline.com/clinical-feed/medical-news-today-0-physical-activity-protects-brain-health-but-only-if-you-enjoy-it-study-says.md)
- [Bupropion Hydrochloride for Improving Recovery in Acute Ischaemic Stroke: BASE Trial Protocol](https://medichelpline.com/clinical-feed/bmj-open-4-protocol-for-base-a-multicentre-double-blind-randomised-controlled-trial-of.md)
- [Loss to Follow-Up in Kaposi Sarcoma at Ocean Road Cancer Institute: Competing-Risks Analysis](https://medichelpline.com/clinical-feed/medrxiv-6-loss-to-follow-up-among-patients-with-kaposi-sarcoma-at-the-ocean-road-cancer.md)
- [Handshake in Medicine: Why Clinicians Should Reconsider Shaking Hands](https://medichelpline.com/clinical-feed/stat-news-4-opinion-medicine-stopped-shaking-hands-we-should-start-again.md)

## Navigation
- [← Back to Neurology Feed](https://medichelpline.com/clinical-feed/neurology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.