Background

White matter injury (WMI) and impaired neurodevelopment are common in children with congenital heart disease. However, the effect of WMI on neurodevelopmental outcomes is still rarely reported. In this study, we aimed to investigate microstructural changes in white matter (WM) and its relationship with neurodevelopmental outcomes and further explore the underlying neurophysiological mechanisms of neurocognitive impairments in the tetralogy of Fallot (ToF).

Method

Diffusion tensor imaging (DTI) data were acquired in preschool-aged children with ToF (n = 29) and normal controls (NC, n = 19), and neurodevelopmental assessments were performed with the Wechsler Preschool and Primary Scale of Intelligence in ToF. The differences in DTI metrics including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were evaluated between ToF and NC. Correlations between WM microstructural changes and neurodevelopmental outcomes were further analyzed.

Results

Significant WM differences were found in the uncinate fasciculus, cingulum hippocampus, superior longitudinal fasciculus, and corticospinal tract between children with ToF and NC. Impaired WM integrity was correlated with the verbal comprehension index and working memory index in ToF.

Conclusions

This study demonstrated WM microstructure injury, and this injury is related to worse language and working memory performance in preschool-aged children with ToF. These findings suggested that DTI metrics may be a potential biomarker of neurocognitive impairments in ToF and can be used to predict future neurodevelopmental outcomes, which also provide new insights into the underlying neurophysiological mechanisms of neurocognitive impairments in ToF.

中文翻译：

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法洛四联症中与神经发育结果相关的异常白质组织：基于图谱的扩散张量成像研究

背景

白质损伤 (WMI) 和神经发育受损在先天性心脏病患儿中很常见。然而，WMI 对神经发育结果的影响仍然很少报道。在本研究中，我们旨在研究白质 (WM) 的微观结构变化及其与神经发育结果的关系，并进一步探索法洛四联症 (ToF) 中神经认知障碍的潜在神经生理机制。

方法

在 ToF (n = 29) 和正常对照 (NC, n = 19) 的学龄前儿童中获取扩散张量成像 (DTI) 数据，并使用 Wechsler Preschool and Primary Scale of Intelligence in ToF 进行神经发育评估。在 ToF 和 NC 之间评估了 DTI 指标的差异，包括分数各向异性、平均扩散率、轴向扩散率和径向扩散率。进一步分析了 WM 微结构变化与神经发育结果之间的相关性。

结果

在 ToF 和 NC 患儿的钩束、扣带回海马、上纵束和皮质脊髓束中发现了显着的 WM 差异。受损的 WM 完整性与 ToF 中的语言理解指数和工作记忆指数相关。

结论

这项研究证明了 WM 微结构损伤，并且这种损伤与 ToF 学龄前儿童的语言和工作记忆表现较差有关。这些发现表明，DTI 指标可能是 ToF 中神经认知障碍的潜在生物标志物，可用于预测未来的神经发育结果，这也为 ToF 中神经认知障碍的潜在神经生理机制提供了新的见解。