Chen Yingqian, Wang Miaomiao, Su Shu, Dai Yan, Zou Mengsha, Lin Liping, Qian Long, Li Xianjun, Zhang Hongyu, Liu Meina, Chu Jianping, Yang Jian, Yang Zhiyun
Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Eur Radiol. 2024 Mar;34(3):1444-1452. doi: 10.1007/s00330-023-10220-2. Epub 2023 Sep 6.
Whether the alternation of the glymphatic system exists in neurodevelopmental disease still remains unclear. In this study, we investigated structural and functional changes in the glymphatic system in the treatment-naïve attention-deficit/hyperactivity disorder (ADHD) children by quantitatively measuring the Virchow-Robin spaces (VRS) volume and diffusion tensor image-analysis along the perivascular space (DTI-ALPS).
Forty-seven pediatric ADHD patients and 52 age- and gender-matched typically developing (TD) children were recruited in this prospective study. The VRS volume was calculated using a semi-automated approach in axial T2-weighted images. Diffusivities along the x-, y-, and z-axes in the projection, association, and subcortical neural fiber areas were measured. The ALPS index, a ratio that accentuated water diffusion along the perivascular space, was calculated. The Mann-Whitney U test was used to compare the quantitative parameters; Pearson's correlation was used to analyze the correlation with clinical symptoms.
The cerebral VRS volume (mean, 15.514 mL vs. 11.702 mL) and the VRS volume ratio in the ADHD group were larger than those in the TD group (all p < 0.001). The diffusivity along the x-axis in association fiber area and ALPS index were significantly smaller in the ADHD group vs. TD group (mean, 1.40 vs.1.59, p < 0.05 after false discovery rate adjustment). Besides, the ALPS index was related to inattention symptoms of ADHD (r = - 0.323, p < 0.05).
Our study suggests that the glymphatic system alternation may participate in the pathogenesis of ADHD, which may be a new research direction for exploring the mechanisms of psycho-behavioral developmental disorders. Moreover, the VRS volume and ALPS index could be used as the metrics for diagnosing ADHD.
Considering the potential relevance of the glymphatic system for exploring the mechanisms of attention deficit/hyperactivity, the Virchow-Robin spaces volume and the analysis along the perivascular space index could be used as additional metrics for diagnosing the disorder.
• Increased Virchow-Robin space volume and decreased analysis along the perivascular space index were found in the treatment-naïve attention-deficit/hyperactivity disorder children. • The results of this study indicate that the glymphatic system alternation may have a valuable role in the pathogenesis of attention-deficit/hyperactivity disorder. • The analysis along the perivascular space index is correlated with inattention symptoms of attention-deficit/hyperactivity disorder children.
神经发育疾病中类淋巴系统是否存在改变仍不清楚。在本研究中，我们通过定量测量魏尔啸-罗宾间隙（VRS）体积以及沿血管周围间隙的扩散张量成像分析（DTI-ALPS），研究未经治疗的注意力缺陷多动障碍（ADHD）儿童类淋巴系统的结构和功能变化。
本前瞻性研究招募了47名儿科ADHD患者和52名年龄及性别匹配的发育正常（TD）儿童。在轴向T2加权图像中使用半自动方法计算VRS体积。测量投射、联合和皮质下神经纤维区域沿x、y和z轴的扩散率。计算ALPS指数，即强调沿血管周围间隙水扩散的比率。采用曼-惠特尼U检验比较定量参数；采用皮尔逊相关性分析与临床症状的相关性。
ADHD组的脑VRS体积（平均15.514 mL对11.702 mL）和VRS体积比均大于TD组（均p<0.001）。与TD组相比，ADHD组联合纤维区域沿x轴的扩散率和ALPS指数显著更小（平均1.40对1.59，经错误发现率校正后p<0.05）。此外，ALPS指数与ADHD的注意力不集中症状相关（r=-0.323，p<0.05）。
我们的研究表明，类淋巴系统改变可能参与ADHD的发病机制，这可能是探索心理行为发育障碍机制的一个新研究方向。此外，VRS体积和ALPS指数可作为诊断ADHD的指标。
考虑到类淋巴系统对探索注意力缺陷/多动机制的潜在相关性，魏尔啸-罗宾间隙体积和沿血管周围间隙指数分析可作为诊断该疾病的额外指标。
• 在未经治疗的注意力缺陷/多动障碍儿童中发现魏尔啸-罗宾间隙体积增加，沿血管周围间隙指数分析降低。• 本研究结果表明，类淋巴系统改变可能在注意力缺陷/多动障碍的发病机制中发挥重要作用。• 沿血管周围间隙指数分析与注意力缺陷/多动障碍儿童的注意力不集中症状相关。
