The Effect of Abnormal Regional Homogeneity and Spontaneous Low-Frequency Brain Activity on Lower Cognitive Ability: A Cross-Sectional Study on Postoperative Children With Tetralogy of Fallot

Abstract

Despite intracardiac malformation correction, children with Tetralogy of Fallot (TOF) may still suffer from brain injury. This cross-sectional study was primarily designed to determine the relationship between blood oxygenation level-dependent (BOLD) signal changes after surgery and cognition in school-aged children with TOF. To evaluate the differences between TOF children (n = 9) and healthy children (n = 9), resting-state functional magnetic resonance imaging (rs-fMRI) and the Wechsler Intelligence Scale for Children-Chinese revised edition (WISC-CR) were conducted in this study. The results showed that TOF children had a lower full-scale intelligence quotient (FSIQ, 95.444 ± 5.354, p = 0.022) and verbal intelligence quotient (VIQ, 92.444 ± 4.708, p = 0.003) than healthy children (FSIQ = 118.500 ± 4.330;VIQ = 124.250 ± 4.404), and that significant differences in regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) existed between the two groups. Besides, VIQ had significantly positive correlations with the decreased ALFF value of the middle inferior occipital gyrus (MIOG, beta = 0.908, p = 0.012) after fully adjusting for all covariates. In addition, elevated ReHo values of the left and right precuneus were positively related to ALFF in the MIOG. This study revealed that brain injury substantially influences neural activity and cognition in postoperative TOF children, providing direct evidence of an association between BOLD signal changes and the VIQ and prompting further attention to language development in TOF children.

Keywords: ALFF; ReHo; Tetralogy of Fallot; VIQ; brain injury; cognition.

FIGURE 1

Compared with HC, TOF children showed increased ReHo values in the right brainstem, right middle occipital gyrus, right inferior parietal gyrus, right precuneus, and left precuneus, and decreased ReHo values in the right posterior lobe of the cerebellum and right inferior temporal gyrus. AlphaSim correction with P < 0.01; cluster size > 23.

FIGURE 2

Compared with HC, TOF children had higher ALFF values in the left medial prefrontal cortex, left cingulum, and right parahippocampal gyrus, but lower ALFF values in the bilateral cerebellum, left middle inferior occipital gyrus, and left inferior occipital gyrus. AlphaSim correction with P < 0.05; cluster size > 65.