Wong Alex Mun-Ching, Siow Tiing-Yee, Cheng Yi-Ting, Lin Eddy Chien-Yuan, Lin Shin-Nan, Lin Kuang-Lin, Toh Cheng-Hong
Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Magn Reson Imaging. 2025 Jul;120:110398. doi: 10.1016/j.mri.2025.110398. Epub 2025 Apr 26.
The glymphatic system, crucial for brain waste removal and homeostasis, has an underexplored developmental trajectory in children. This study describes changes in glymphatic function during childhood via diffusion tensor imaging-analysis along the perivascular space (DTI-ALPS).
We retrospectively studied DTI MR images of 72 pediatric participants (mean age = 92.37 months; 0-19.8 years; 50 % females), all showing normal MRI findings from 2019 to 2022. Imaging utilized 3 T scanners with a DTI sequence of 21 diffusion-encoded gradients, focusing on the ALPS index to assess glymphatic function. Clinical outcomes were determined using the Pediatric Cerebral Performance Category Scale and medical records within two weeks post-MRI. Regions-of-interest on diffusion maps were selected manually, guided by fractional anisotropy maps, for automatic ALPS computation. Pearson correlation and multiple linear regression analyzed the relationship between ALPS indices, age, and clinical scores, with a paired t-test comparing bilateral ALPS indices. Significance was set at P < 0.05.
Significant positive correlations between age and both left (R = 0.510, P < 0.001) and right (R = 0.688, P < 0.001) DTI-ALPS indices were observed, indicating developmental changes in glymphatic function. Age alone significantly predicted the DTI-ALPS indices (left ALPS: adjusted R = 0.235; right ALPS: adjusted R = 0.460), underscoring its developmental trajectory. The study found no significant differences between left and right DTI-ALPS indices, suggesting symmetrical glymphatic function during childhood.
This study reveals developmental changes in the glymphatic system across childhood, demonstrating an age-related increase in glymphatic function and bilateral symmetry.
淋巴系统对大脑废物清除和内环境稳定至关重要，但其在儿童期的发育轨迹尚未得到充分研究。本研究通过沿血管周围间隙的扩散张量成像分析（DTI-ALPS）描述了儿童期淋巴功能的变化。
我们回顾性研究了72名儿科参与者（平均年龄=92.37个月；0-19.8岁；50%为女性）的DTI磁共振图像，所有图像均显示2019年至2022年的MRI结果正常。成像使用3T扫描仪，采用21个扩散编码梯度的DTI序列，重点关注ALPS指数以评估淋巴功能。临床结果通过儿科脑功能表现分类量表和MRI后两周内的病历确定。在分数各向异性图的指导下，手动选择扩散图上的感兴趣区域，以自动计算ALPS。Pearson相关性和多元线性回归分析了ALPS指数、年龄和临床评分之间的关系，并使用配对t检验比较双侧ALPS指数。显著性设定为P<0.05。
观察到年龄与左侧（R=0.510，P<0.001）和右侧（R=0.688，P<0.001）DTI-ALPS指数之间存在显著正相关，表明淋巴功能存在发育变化。仅年龄就显著预测了DTI-ALPS指数（左侧ALPS：调整后R=0.235；右侧ALPS：调整后R=0.460），突出了其发育轨迹。研究发现左侧和右侧DTI-ALPS指数之间没有显著差异，表明儿童期淋巴功能对称。
本研究揭示了儿童期淋巴系统的发育变化，表明淋巴功能随年龄增长而增加且呈双侧对称。
