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Altered brain diffusion tensor imaging indices in adolescents with the Fontan palliation

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

Single ventricle heart disease (SVHD) patients show injury in brain sites that regulate autonomic, mood, and cognitive functions. However, the nature (acute or chronic changes) and extent of brain injury in SVHD are unclear. Our aim was to examine regional brain tissue damage in SVHD over controls using DTI-based mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) procedures.

Methods

We collected two DTI series (3.0-T MRI), mood and cognitive data, from 27 SVHD and 35 control adolescents. Whole-brain MD, AD, RD, and FA maps were calculated from each series, realigned and averaged, normalized to a common space, smoothed, and compared between groups using ANCOVA (covariates, age and sex; false discovery rate, p < 0.05). Region-of-interest analyses were performed to calculate MD, AD, RD, and FA values for magnitude assessment between groups.

Results

SVHD patients showed impaired mood and cognitive functions over healthy adolescents. Multiple brain sites in SVHD showed increased MD values, including the insula, caudate, cingulate, hypothalamus, thalamus, medial prefrontal and frontal cortices, parahippocampal gyrus, hippocampus, precentral gyrus, amygdala, cerebellum, corpus callosum, basal forebrain, mammillary bodies, internal capsule, midbrain, fornix, and occipital, parietal, and temporal cortices, indicating chronic tissue changes. Similar areas showed either increased AD or RD values, with RD changes more enhanced over AD in SVHD compared to controls. Few brain regions emerged with increased or decreased FA values in SVHD patients over controls.

Conclusion

SVHD adolescents, more than a decade from their last surgical procedure, show widespread brain abnormalities in autonomic, mood, and cognitive regulatory areas. These findings indicate that brain injury is in a chronic stage in SVHD with predominantly myelin changes that may result from previous hypoxia/ischemia- or developmental-induced processes.

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Acknowledgements

Authors would like to thank Patty Chung, and Paola Moreno for assistance with data collection.

Funding

This study was funded by the National Institutes of Health R01NR016463.

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Author notes

  1. SS and BR contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA

    Sadhana Singh, Ebenezer Daniel, Luke Ehlert & Rajesh Kumar

  2. UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA

    Bhaswati Roy, Nancy Pike & Mary A. Woo

  3. Division of Cardiology, Children’s Hospital, Los Angeles, CA, USA

    Alan B. Lewis

  4. Division of Pediatric Cardiology, University of California Los Angeles, Los Angeles, CA, USA

    Nancy Halnon

  5. Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA

    Rajesh Kumar

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  1. Sadhana Singh
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  9. Rajesh Kumar
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Correspondence to Rajesh Kumar.

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Singh, S., Roy, B., Pike, N. et al. Altered brain diffusion tensor imaging indices in adolescents with the Fontan palliation. Neuroradiology 61, 811–824 (2019). https://doi.org/10.1007/s00234-019-02208-x

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