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. 2025 Apr 12;51(1):115.
doi: 10.1186/s13052-025-01962-4.

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

Zhen Zhang #  1 , Siyu Ma #  1 , Ziqing Hu #  1 , Yong Chen  1 , Ye Lin  1 , Yaqi Zhang  1 , Meijiao Zhu  2 , Liang Hu  1 , Xinyu Cai  1 , Nishant Patel  1 , Ming Yang  3 , Xuming Mo  4   5
Affiliations

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

Zhen Zhang et al. Ital J Pediatr. .

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.

Keywords: Diffusion tensor imaging; Neurodevelopmental deficit; White matter microstructural changes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The studies involving human participants were reviewed and approved by the Ethics Committee of Children’s Hospital of Nanjing Medical University. The study is in accordance with the 1964 Helsinki Declaration and its later amendments. Written informed consent to participate in this study was provided by the legal guardian/next of kin of the participants for the publication of any potentially identifiable radiographic images or data included in this article. Consent for publication: Not applicable. Competing interests: The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Lower FA in cyanotic infants compared to acyanotic infants Sagittal, coronal, and axial views of white matter microstructures show significantly lower FA in cyanotic infants compared to acyanotic infants. Red color indicates voxels where FA is significantly lower (TFCE corrected P < 0.05) in the cyanotic group compared to acyanotic group. L = Left, R = Right, P = Posterior, A = Anterior
Fig. 2
Fig. 2
Lower FA in cyanotic infants compared to acyanotic infants. White matter microstructures show significantly lower FA in cyanotic infants compared to acyanotic infants at different brain scanning levels. Red color indicates voxels where FA is significantly lower (TFCE corrected P < 0.05) in the cyanotic group compared to the acyanotic group
See this image and copyright information in PMC

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