Hu Rui, Tan Fan, Chen Wen, Wu Yong, Jiang Yuhan, Du Wei, Zuo Yuchen, Gao Bingbing, Song Qingwei, Miao Yanwei
Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
Front Psychiatry. 2023 Aug 22;14:1237113. doi: 10.3389/fpsyt.2023.1237113. eCollection 2023.
To explore the specific alterations of white matter microstructure in children with attention-deficit/hyperactivity disorder (ADHD) by automated fiber quantification (AFQ) and tract-based spatial statistics (TBSS), and to analyze the correlation between white matter abnormality and impairment of executive function.
In this prospective study, a total of twenty-seven patients diagnosed with ADHD (20 males, 7 females; mean age of 8.89 ± 1.67 years) and twenty-two healthy control (HC) individuals (11 males, 11 females, mean age of 9.82 ± 2.13 years) were included. All participants were scanned with diffusion kurtosis imaging (DKI) and assessed for executive functions. AFQ and TBSS analysis methods were used to investigate the white matter fiber impairment of ADHD patients, respectively. Axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD) and fractional anisotropy (FA) of 17 fiber properties were calculated using the AFQ. The mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) and fractional anisotropy (FA) of DKI and AD, RD, MD, and FA of diffusion tensor imaging (DTI) assessed the integrity of the white matter based on TBSS. Partial correlation analyses were conducted to evaluate the correlation between white matter abnormalities and clinical test scores in ADHD while taking age, gender, and education years into account. The analyses were all family-wise error rate (FWE) corrected.
ADHD patients performed worse on the Behavior Rating Inventory of Executive Function (BRIEF) test ( < 0.05). Minor variances existed in gender and age between ADHD and HC, but these variances did not yield statistically significant distinctions. There were no significant differences in TBSS for DKI and DTI parameters ( > 0.05, TFCE-corrected). Compared to HC volunteers, the mean AD value of right cingulum bundle (CB_R) fiber tract showed a significantly higher level in ADHD patients following the correction of FWE. As a result of the point-wise comparison between groups, significant alterations (FWE correction, < 0.05) were mainly located in AD (nodes 36-38, nodes 83-97) and MD (nodes 92-95) of CB_R. There was no significant correlation between white matter diffusion parameters and clinical test scores in ADHD while taking age, gender, and education years into account.
The AFQ method can detect ADHD white matter abnormalities in a specific location with greater sensitivity, and the CB_R played a critical role. Our findings may be helpful in further studying the relationship between focal white matter abnormalities and ADHD.
通过自动纤维定量（AFQ）和基于束的空间统计学（TBSS）方法，探索注意缺陷多动障碍（ADHD）患儿白质微观结构的具体改变，并分析白质异常与执行功能损害之间的相关性。
在这项前瞻性研究中，共纳入27例诊断为ADHD的患者（男20例，女7例；平均年龄8.89±1.67岁）和22名健康对照（HC）个体（男11例，女11例；平均年龄9.82±2.13岁）。所有参与者均接受扩散峰度成像（DKI）扫描并进行执行功能评估。分别采用AFQ和TBSS分析方法研究ADHD患者的白质纤维损害情况。使用AFQ计算17种纤维特性的轴向扩散率（AD）、径向扩散率（RD）、平均扩散率（MD）和各向异性分数（FA）。基于TBSS，通过DKI的平均峰度（MK）、轴向峰度（AK）、径向峰度（RK）、平均扩散率（MD）、轴向扩散率（AD）、径向扩散率（RD）和各向异性分数（FA）以及扩散张量成像（DTI）的AD、RD、MD和FA评估白质的完整性。在考虑年龄、性别和受教育年限的情况下，进行偏相关分析以评估ADHD患者白质异常与临床测试分数之间的相关性。所有分析均采用家族性错误率（FWE）校正。
ADHD患者在执行功能行为评定量表（BRIEF）测试中表现更差（<0.05）。ADHD组与HC组在性别和年龄上存在微小差异，但这些差异无统计学意义。DKI和DTI参数的TBSS分析无显著差异（>0.05，TFCE校正）。与HC志愿者相比，经FWE校正后，ADHD患者右侧扣带束（CB_R）纤维束的平均AD值显著更高。通过组间逐点比较，显著改变（FWE校正，<0.05）主要位于CB_R的AD（节点36 - 38、节点83 - 97）和MD（节点92 - 95）。在考虑年龄、性别和受教育年限的情况下，ADHD患者白质扩散参数与临床测试分数之间无显著相关性。
AFQ方法能够更敏感地检测出ADHD患者特定部位的白质异常，且CB_R起关键作用。我们的研究结果可能有助于进一步研究局灶性白质异常与ADHD之间的关系。
