Glymphatic Imaging in Pediatrics

Li, Xianjun; Lin, Zixuan; Liu, Congcong; Bai, Ruiliang; Wu, Dan; Yang, Jian

doi:10.1002/jmri.29040

Cited by 3 publications

(1 citation statement)

References 118 publications

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“…Although the developmental trajectories of glymphatic system in pediatric HCs are still not fully explored, 43 our findings imply that an early impairment of glymphatic function may be associated with worse cognitive performance in pediatric MS patients. Our results are also consistent with a growing body of evidence showing an association between glymphatic dysfunction and cognitive decline in adult aging 12,13 and different neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, and idiopathic normal pressure hydrocephalus.…”

Section: Discussionmentioning

confidence: 71%

Cognitive Impairment Is Related to Glymphatic System Dysfunction in Pediatric Multiple Sclerosis

Margoni,

Pagani,

Meani

et al. 2024

Annals of Neurology

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ObjectiveThe aim of this study was to investigate whether, compared to pediatric healthy controls (HCs), the glymphatic system is impaired in pediatric multiple sclerosis (MS) patients according to their cognitive status, and to assess its association with clinical disability and MRI measures of brain structural damage.MethodsSixty‐five pediatric MS patients (females = 62%; median age = 15.5 [interquartile range, IQR = 14.5;17.0] years) and 23 age‐ and sex‐matched HCs (females = 44%; median age = 14.1 [IQR = 11.8;16.2] years) underwent neurological, neuropsychological and 3.0 Tesla MRI assessment, including conventional and diffusion tensor imaging (DTI). We calculated the diffusion along the perivascular space (DTI‐ALPS) index, a proxy of glymphatic function. Cognitive impairment (Co‐I) was defined as impairment in at least 2 cognitive domains.ResultsNo significant differences in DTI‐ALPS index were found between HCs and cognitively preserved (Co‐P) pediatric MS patients (estimated mean difference [EMD] = −0.002 [95% confidence interval = −0.069; 0.065], FDR‐p = 0.956). Compared to HCs and Co‐P patients, Co‐I pediatric MS patients (n = 20) showed significantly lower DTI‐ALPS index (EMD = −0.136 [95% confidence interval = −0.214; −0.058], FDR‐p ≤ 0.004). In HCs, no associations were observed between DTI‐ALPS index and normalized brain, cortical and thalamic volumes, and normal‐appearing white matter (NAWM) fractional anisotropy (FA) and mean diffusivity (MD) (FDR‐p ≥ 0.348). In pediatric MS patients, higher brain WM lesion volume (LV), higher NAWM MD, lower normalized thalamic volume, and lower NAWM FA were associated with lower DTI‐ALPS index (FDR‐p ≤ 0.016). Random Forest selected lower DTI‐ALPS index (relative importance [RI] = 100%), higher brain WM LV (RI = 59.5%) NAWM MD (RI = 57.1%) and intelligence quotient (RI = 51.3%) as informative predictors of cognitive impairment (out‐of‐bag area under the curve = 0.762).InterpretationGlymphatic system dysfunction occurs in pediatric MS, is associated with brain focal lesions, irreversible tissue loss accumulation and cognitive impairment. ANN NEUROL 2024

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Section: Discussionmentioning

confidence: 71%

Cognitive Impairment Is Related to Glymphatic System Dysfunction in Pediatric Multiple Sclerosis

Margoni,

Pagani,

Meani

et al. 2024

Annals of Neurology

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The glymphatic system in migraine and other headaches

Vittorini,

Sahin,

Trojan

et al. 2024

J Headache Pain

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Glymphatic system is an emerging pathway of removing metabolic waste products and toxic solutes from the brain tissue. It is made of a network of perivascular spaces, filled in cerebrospinal and interstitial fluid, encompassing penetrating and pial vessels and communicating with the subarachnoid space. It is separated from vessels by the blood brain barrier and from brain tissue by the endfeet of the astrocytes rich in aquaporin 4, a membrane protein which controls the water flow along the perivascular space. Animal models and magnetic resonance (MR) studies allowed to characterize the glymphatic system function and determine how its impairment could lead to numerous neurological disorders (e.g. Alzheimer’s disease, stroke, sleep disturbances, migraine, idiopathic normal pressure hydrocephalus). This review aims to summarize the role of the glymphatic system in the pathophysiology of migraine in order to provide new ways of approaching to this disease and to its therapy.

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Association of Glymphatic and White Matter Impairment With the Postoperative Outcome of Pediatric Hydrocephalus

Zhao,

OuYang,

Zhang

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Assessment of postoperative outcomes on pediatric hydrocephalus is critical for adjusting treatment strategies. The aim of this work was to investigate the ability of MRI metrics to predict postoperative outcomes. METHODS: A total of 55 children with hydrocephalus who underwent MRI and ventriculoperitoneal shunt surgery were prospectively enrolled. MRI was also performed at 6 months postoperatively in 33 of the 55 children. A total of 92 controls matched for age and sex were enrolled and divided into preoperative and postoperative control groups. We calculated the diffusion tensor imaging along the perivascular space (DTI-ALPS) index, Evans index, and diffusion tensor imaging metrics. The ability of various metrics to predict postoperative outcomes was assessed using receiver operating characteristic curve analysis. RESULTS: The DTI-ALPS index was significantly lower in patients with hydrocephalus than in controls. The abnormal DTI-ALPS index trended toward the normal range after surgery. Patients with lower preoperative DTI-ALPS index, lower fractional anisotropy (FA), and higher radial diffusivity in association fibers had less favorable short-term outcomes. Patients with worse long-term outcomes had lower postoperative DTI-ALPS index, higher postoperative Evans index, and lower FA and higher radial diffusivity in association fibers. Predictive performance was better when the DTI-ALPS index and FA in association fibers were used in combination than when either of these metrics was used alone. CONCLUSION: The DTI-ALPS index and FA in association fibers provided complementary information for prognostic assessment after the ventriculoperitoneal shunt surgery on pediatric hydrocephalus. A combination of DTI-ALPS index and FA would improve our ability to predict postoperative outcomes in these patients.

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Glymphatic Imaging in Pediatrics

Cited by 3 publications

References 118 publications

Cognitive Impairment Is Related to Glymphatic System Dysfunction in Pediatric Multiple Sclerosis

Cognitive Impairment Is Related to Glymphatic System Dysfunction in Pediatric Multiple Sclerosis

The glymphatic system in migraine and other headaches

Association of Glymphatic and White Matter Impairment With the Postoperative Outcome of Pediatric Hydrocephalus

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