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Gertsvolf N, Votava-Smith JK, Ceschin R, Del Castillo S, Lee V, Lai HA, Bluml S, Paquette L, Panigrahy A. Association between Subcortical Morphology and Cerebral White Matter Energy Metabolism in Neonates with Congenital Heart Disease. Sci Rep 2018; 8:14057. [PMID: 30232359 PMCID: PMC6145929 DOI: 10.1038/s41598-018-32288-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022] Open
Abstract
Complex congenital heart disease (CHD) is associated with neurodevelopmental impairment, the mechanism of which is unknown. Cerebral cortical dysmaturation in CHD is linked to white matter abnormalities, including developmental vulnerability of the subplate, in relation to oxygen delivery and metabolism deficits. In this study, we report associations between subcortical morphology and white matter metabolism in neonates with CHD using quantitative magnetic resonance imaging (MRI) and spectroscopy (MRS). Multi-modal brain imaging was performed in three groups of neonates close to term-equivalent age: (1) term CHD (n = 56); (2) preterm CHD (n = 37) and (3) preterm control group (n = 22). Thalamic volume and cerebellar transverse diameter were obtained in relation to cerebral metrics and white matter metabolism. Short echo single-voxel MRS of parietal and frontal white matter was used to quantitate metabolites related to brain maturation (n-acetyl aspartate [NAA], choline, myo-inositol), neurotransmitter (glutamate), and energy metabolism (glutamine, citrate, creatine and lactate). Multi-variate regression was performed to delineate associations between subcortical morphological measurements and white matter metabolism controlling for age and white matter injury. Reduced thalamic volume, most pronounced in the preterm control group, was associated with increased citrate levels in all three group in the parietal white matter. In contrast, reduced cerebellar volume, most pronounced in the preterm CHD group, was associated with reduced glutamine in parietal grey matter in both CHD groups. Single ventricle anatomy, aortic arch obstruction, and cyanotic lesion were predictive of the relationship between reduced subcortical morphometry and reduced GLX (particularly glutamine) in both CHD cohorts (frontal white matter and parietal grey matter). Subcortical morphological associations with brain metabolism were also distinct within each of the three groups, suggesting these relationships in the CHD groups were not directly related to prematurity or white matter injury alone. Taken together, these findings suggest that subplate vulnerability in CHD is likely relevant to understanding the mechanism of both cortical and subcortical dysmaturation in CHD infants. Future work is needed to link this potential pattern of encephalopathy of CHD (including the constellation of grey matter, white matter and brain metabolism deficits) to not only abnormal fetal substrate delivery and oxygen conformance, but also regional deficits in cerebral energy metabolism.
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Affiliation(s)
- Nina Gertsvolf
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jodie K Votava-Smith
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Rafael Ceschin
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Sylvia Del Castillo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Anesthesiology, Critical Care Medicine Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Vince Lee
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Hollie A Lai
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Stefan Bluml
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Lisa Paquette
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, USA.
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, USA.
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
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