Upper-Limb Amputation Disrupts the Interhemispheric Structural Rather than Functional Connectivity

Abstract

Background: Recent neuroimaging studies on upper-limb amputation have revealed the reorganization of bilateral sensorimotor cortex after sensory deprivation, underpinning the assumption of changes in the interhemispheric connections. In the present study, using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we aim to explore the alterations in the interhemispheric functional and structural connectivity after upper-limb amputation. Methods: Twenty-two upper-limb amputees and 15 age- and sex-matched healthy controls were recruited for MRI scanning. The amputees were further divided into subgroups by amputation side and residual limb pain (RLP). DTI metrics of corpus callosum (CC) subregions and resting-state functional connectivity (FC) between the bilateral sensorimotor cortices were measured for each participant. Linear mixed models were carried out to investigate the relationship of interhemispheric connectivity with the amputation, amputation side, and RLP. Results: Compared with healthy controls, upper-limb amputees showed lower axial diffusivity (AD) in CC subregions II and III. Subgroup analyses showed that the dominant hand amputation induced significant microstructural changes in CC subregion III. In addition, only amputees with RLP showed decreased fractional anisotropy and AD in CC, which was also correlated with the intensity of RLP. No significant changes in interhemispheric FC were found after upper-limb amputation. Conclusion: The present study demonstrated that the interhemispheric structural connectivity rather than FC degenerated after upper-limb amputation, and the degeneration of interhemispheric structural connectivity was shown to be relevant to the amputation side and the intensity of RLP. Impact statement Neuroimaging studies have revealed the functional reorganization of bilateral sensorimotor cortex after amputation, with expanded activation from the intact hemisphere to the deprived hemisphere. Our findings indicated a degeneration of interhemispheric white matter connections in upper-limb amputees, unveiling the underlying structural basis for bilateral functional reorganization after amputation.

Keywords: amputation side; corpus callosum; interhemispheric connectivity; residual limb pain; upper-limb amputation.