Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Learning and Developmental Center, Child Mind Institute, New York, NY.
Semin Thorac Cardiovasc Surg. 2022 Winter;34(4):1285-1295. doi: 10.1053/j.semtcvs.2021.10.014. Epub 2021 Nov 10.
To identify regional cerebral blood flow (rCBF) alterations in children and adolescents with congenital heart disease (CHD) in relation to neurocognitive outcomes using a nonbiased data-driven approach. This is a prospective, observational study of children and adolescents with CHD without brain injury and healthy controls using pseudo-continuous arterial spin labeling (pCASL) MRI. Quantitative rCBF was compared between participants with CHD and healthy controls using a voxelwise data-driven method. Mediation analysis was then performed on a voxelwise basis, with the grouping variable as the independent variable, neurocognitive outcomes (from the NIH Toolbox Cognitive Battery) as the dependent variables, and rCBF as the mediator. After motion correction, a total of 80 studies were analyzable (27 for patients with CHD, 53 for controls). We found steeper age-related decline in rCBF among those with CHD compared to normal controls in the insula/ventromedial prefrontal regions (salience network) and the dorsal anterior cingulate and precuneus/posterior cingulate (default mode network), and posterior parietal/dorsolateral prefrontal (central executive network) (FWE-corrected P< 0.05). The reduced rCBF in the default mode/salience network was found to mediate poorer performance on an index of crystallized cognition from the NIH Toolbox Cognitive Battery in those with CHD compared to controls. In contrast, reduced rCBF in the central executive network/salience network mediated reduced deficits in fluid cognition among patients with CHD compared to controls. Regional cerebral blood flow alterations mediate domain-specific differences in cognitive performance in children and adolescents with CHD compared to healthy controls, independent of injury, and are likely related to brain and cognitive reserve mechanisms. Further research is needed to evaluate the potential of interventions in CHD targeting regional cerebral blood flow across lifespan.
为了使用无偏数据驱动方法，确定先天性心脏病 (CHD) 患儿和青少年的区域性脑血流 (rCBF) 改变与神经认知结果的关系。这是一项前瞻性、观察性研究，对无脑损伤的 CHD 患儿和青少年以及健康对照者使用伪连续动脉自旋标记 (pCASL) MRI。采用基于体素的数据驱动方法比较 CHD 患儿和健康对照者的 rCBF。然后在基于体素的基础上进行中介分析，以分组变量为自变量，神经认知结果（来自 NIH 工具包认知电池）为因变量，rCBF 为中介。经过运动校正后，共有 80 项研究可分析（CHD 患者 27 项，对照组 53 项）。我们发现，与正常对照组相比，CHD 患者大脑岛叶/腹内侧前额叶区域（突显网络）和背侧前扣带回和楔前叶/后扣带回（默认模式网络）以及后顶叶/背外侧前额叶（中央执行网络）的 rCBF 随年龄的相关性下降更为陡峭（FWE 校正后 P<0.05）。与对照组相比，CHD 患者的默认模式/突显网络中的 rCBF 减少与 NIH 工具包认知电池中晶体认知指数的表现较差有关。相比之下，CHD 患者的中央执行网络/突显网络中的 rCBF 减少与认知缺损的流体认知能力降低有关。与健康对照组相比，rCBF 的改变介导了 CHD 患儿特定认知领域的认知表现差异，独立于损伤，可能与大脑和认知储备机制有关。需要进一步研究，评估在整个生命过程中针对 CHD 患者的区域性脑血流进行干预的潜力。
