Zhang Zhen, Ma Siyu, Hu Ziqing, Chen Yong, Lin Ye, Zhang Yaqi, Zhu Meijiao, Hu Liang, Cai Xinyu, Patel Nishant, Yang Ming, Mo Xuming
Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China.
Department of Radiology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
Ital J Pediatr. 2025 Apr 12;51(1):115. doi: 10.1186/s13052-025-01962-4.
Neurodevelopmental deficits(NDs) frequently occur in patients with cyanotic congenital heart disease (CCHD) because of the hemodynamic abnormalities. We aimed to evaluate white matter(WM) microstructural changes in infants with CHD and analyze the relationship between WM microstructural changes and NDs.
A total of 40 infants, 20 with CCHD and 20 with ACHD (matched on age and sex), who underwent preoperative DTI scanning were prospectively enrolled in the study. Multiple linear regression analysis were used to investigate the associations between brain microstructural changes and both clinical variables and neurodevelopmental outcomes, assessed with Gesell Developmental Schedules-Third Edition (GDS-III).
Infants with CCHD showed lower fractional anisotropy (FA) values in the bilateral cingulum hippocampus (CGH), right anterior thalamic radiation (ATR), and forceps minor (fminor) and exhibited poorer performance in adaptive, motor, language, and personal-social behaviors (all P < 0.05). For CHD infants, the FA values of fminor were positively correlated with adaptive, fine motor, and language behaviors (P = 0.026, 0.040, and 0.038, respectively). The microstructures of right ATR were positively correlated with adaptive and fine motor behaviors (P = 0.047 and 0.035, respectively), and FA values of right CGH were positively correlated with language behavior (P = 0.007). Hypoxia-related indicators and the internal diameters of the heart and large vessels were associated with neurodevelopmental and brain microstructural changes.
This study suggests that cerebral white matter microstructural changes may serve as imaging markers of neurodevelopmental deficits, with oxygen supply playing a crucial role in white matter microstructural development.
由于血流动力学异常，发绀型先天性心脏病（CCHD）患者常出现神经发育缺陷（NDs）。我们旨在评估先天性心脏病（CHD）婴儿的白质（WM）微观结构变化，并分析WM微观结构变化与NDs之间的关系。
本研究前瞻性纳入了40例接受术前扩散张量成像（DTI）扫描的婴儿，其中20例为CCHD患儿，20例为非发绀型先天性心脏病（ACHD）患儿（年龄和性别匹配）。采用多元线性回归分析来研究脑微观结构变化与临床变量以及用格塞尔发育量表第三版（GDS-III）评估的神经发育结局之间的关联。
CCHD婴儿在双侧扣带回海马（CGH）、右侧丘脑前辐射（ATR）和小钳（fminor）中的分数各向异性（FA）值较低，并且在适应性、运动、语言和个人社交行为方面表现较差（所有P<0.05）。对于CHD婴儿，fminor的FA值与适应性、精细运动和语言行为呈正相关（分别为P = 0.026、0.040和0.038）。右侧ATR的微观结构与适应性和精细运动行为呈正相关（分别为P = 0.047和0.035），右侧CGH的FA值与语言行为呈正相关（P = 0.007）。缺氧相关指标以及心脏和大血管的内径与神经发育和脑微观结构变化有关。
本研究表明，脑白质微观结构变化可能作为神经发育缺陷的影像学标志物，其中氧供应在白质微观结构发育中起关键作用。
