In many patients, ostensible idiopathic attention deficit-hyperactivity disorder (ADHD) may actually stem from covert prenatal alcohol exposure (PAE), a treatment-relevant distinction. This study attempted a receiver-operator characteristic (ROC) classification of children with ADHD into those with PAE (ADHD+PAE) and those without (ADHD-PAE) using neurobehavioral instruments alongside magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) of supraventricular brain white matter. Neurobehavioral, MRS, and DTI endpoints had been suggested by prior findings. Participants included children aged 8–13 years, 23 with ADHD+PAE, 19 with familial ADHD-PAE, and 28 typically developing (TD) controls. With area-under-the-curve (AUC) >0.90, the Conners 3 Parent Rating Scale Inattention (CIn) and Hyperactivity/Impulsivity (CHp) scores and the Behavioral Regulation Index (BRI) of the Behavior Rating Inventory of Executive Function (BRIEF2) excellently distinguished the clinical groups from TD, but not from each other (AUC < 0.70). Combinations of MRS glutamate (Glu) and N-acetyl-compounds (NAA) and DTI mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) yielded “good” (AUC > 0.80) discrimination. Neuroimaging combined with CIn and BRI achieved AUC 0.72 and AUC 0.84, respectively. But neuroimaging combined with CHp yielded 14 excellent combinations with AUC ≥ 0.90 (all p < 0.0005), the best being Glu·AD·RD·CHp/(NAA·FA) (AUC 0.92, sensitivity 1.00, specificity 0.82, p < 0.0005). Using Cho in lieu of Glu yielded AUC 0.83. White-matter microstructure and metabolism may assist efforts to discriminate ADHD etiologies and to detect PAE, beyond the ability of commonly used neurobehavioral measures alone.

在许多患者中，表面上的特发性注意力缺陷多动障碍 (ADHD) 实际上可能源于隐蔽的产前酒精暴露 (PAE)，这是一种与治疗相关的区别。本研究尝试使用神经行为仪器以及磁共振波谱 (MRS) 和扩散张量成像 (DTI) 将 ADHD 儿童的接收者操作特征 (ROC) 分类为患有 PAE (ADHD+PAE) 和没有 (ADHD-PAE) 的儿童室上性脑白质。先前的研究结果表明神经行为、MRS 和 DTI 终点。参与者包括 8-13 岁的儿童、23 名患有 ADHD+PAE 的儿童、19 名患有家族性 ADHD-PAE 的儿童和 28 名典型发育 (TD) 对照。曲线下面积 (AUC) >0.90，Conners 3 家长评分量表注意力不集中 (CIn) 和多动/冲动 (CHp) 分数以及执行功能行为评定量表 (BRIEF2) 的行为调节指数 (BRI) 出色地将临床组与 TD 区分开来，但彼此之间没有区别(AUC < 0.70)。MRS 谷氨酸 (Glu) 和N-乙酰基化合物 (NAA) 和 DTI 平均扩散率 (MD)、轴向扩散率 (AD)、径向扩散率 (RD) 和分数各向异性 (FA) 产生了“良好”(AUC > 0.80) 的辨别力。神经影像学结合 CIn 和 BRI 分别达到 AUC 0.72 和 AUC 0.84。但神经影像学结合 CHp 产生了 14 个 AUC ≥ 0.90 的优秀组合（所有p  < 0.0005），最好的是 Glu·AD·RD·CHp/(NAA·FA)（AUC 0.92，敏感性 1.00，特异性 0.82，p  < 0.0005） . 使用 Cho代替Glu 得到 AUC 0.83。白质微结构和新陈代谢可能有助于区分 ADHD 病因和检测 PAE，这超出了单独使用常用神经行为测量的能力。