Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Pediatrics, Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Sci Rep. 2018 Sep 19;8(1):14057. doi: 10.1038/s41598-018-32288-3.
Complex congenital heart disease (CHD) is associated with neurodevelopmental impairment, the mechanism of which is unknown. Cerebral cortical dysmaturation in CHD is linked to white matter abnormalities, including developmental vulnerability of the subplate, in relation to oxygen delivery and metabolism deficits. In this study, we report associations between subcortical morphology and white matter metabolism in neonates with CHD using quantitative magnetic resonance imaging (MRI) and spectroscopy (MRS). Multi-modal brain imaging was performed in three groups of neonates close to term-equivalent age: (1) term CHD (n = 56); (2) preterm CHD (n = 37) and (3) preterm control group (n = 22). Thalamic volume and cerebellar transverse diameter were obtained in relation to cerebral metrics and white matter metabolism. Short echo single-voxel MRS of parietal and frontal white matter was used to quantitate metabolites related to brain maturation (n-acetyl aspartate [NAA], choline, myo-inositol), neurotransmitter (glutamate), and energy metabolism (glutamine, citrate, creatine and lactate). Multi-variate regression was performed to delineate associations between subcortical morphological measurements and white matter metabolism controlling for age and white matter injury. Reduced thalamic volume, most pronounced in the preterm control group, was associated with increased citrate levels in all three group in the parietal white matter. In contrast, reduced cerebellar volume, most pronounced in the preterm CHD group, was associated with reduced glutamine in parietal grey matter in both CHD groups. Single ventricle anatomy, aortic arch obstruction, and cyanotic lesion were predictive of the relationship between reduced subcortical morphometry and reduced GLX (particularly glutamine) in both CHD cohorts (frontal white matter and parietal grey matter). Subcortical morphological associations with brain metabolism were also distinct within each of the three groups, suggesting these relationships in the CHD groups were not directly related to prematurity or white matter injury alone. Taken together, these findings suggest that subplate vulnerability in CHD is likely relevant to understanding the mechanism of both cortical and subcortical dysmaturation in CHD infants. Future work is needed to link this potential pattern of encephalopathy of CHD (including the constellation of grey matter, white matter and brain metabolism deficits) to not only abnormal fetal substrate delivery and oxygen conformance, but also regional deficits in cerebral energy metabolism.
复杂先天性心脏病(CHD)与神经发育障碍有关,其机制尚不清楚。CHD 中的皮质发育不良与白质异常有关,包括与氧输送和代谢缺陷相关的基板发育脆弱性。在这项研究中,我们使用定量磁共振成像(MRI)和光谱(MRS)报告了 CHD 新生儿的皮质下形态与白质代谢之间的关联。在三组接近足月年龄的新生儿中进行了多模态脑成像:(1)足月 CHD(n=56);(2)早产儿 CHD(n=37)和(3)早产儿对照组(n=22)。获得了与大脑指标和白质代谢相关的丘脑体积和小脑横径。使用大脑成熟(N-乙酰天冬氨酸[NAA]、胆碱、肌醇)、神经递质(谷氨酸)和能量代谢(谷氨酰胺、柠檬酸、肌酸和乳酸)相关的脑代谢物的短回波单体素 MRS 定量测量顶叶和额叶白质。多元回归用于描绘控制年龄和白质损伤后皮质下形态测量值与白质代谢之间的关联。在所有三组中,丘脑体积减少,在早产儿对照组中最为明显,与顶叶白质中柠檬酸水平升高有关。相反,在 CHD 组中,早产儿 CHD 组中最明显的小脑体积减少与顶叶灰质中谷氨酰胺减少有关。单心室解剖、主动脉弓阻塞和紫绀性病变预测了 CHD 两组中 GLX(尤其是谷氨酰胺)减少与皮质下形态测量值减少之间的关系(额叶白质和顶叶灰质)。在这三个组中的每一个中,皮质下形态与脑代谢之间的关联也不同,这表明 CHD 组中的这些关系不仅仅与早产或白质损伤直接相关。总之,这些发现表明 CHD 中的基板脆弱性可能与理解 CHD 婴儿皮质和皮质下发育不良的机制有关。需要进一步的工作将这种潜在的 CHD 脑病模式(包括灰质、白质和脑代谢缺陷)不仅与异常的胎儿底物输送和氧顺应性联系起来,而且与大脑能量代谢的区域缺陷联系起来。