Associations between preoperative cerebral white matter microstructural changes and neurodevelopmental deficits in CHD infants: a diffusion tensor imaging study

Abstract

Background: 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. Methods: 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). Results: 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. Conclusions: 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.