Altered Brain Function in Pediatric Patients With Complete Spinal Cord Injury: A Resting-State Functional MRI Study.

ABSTRACT

BACKGROUND: Injury to the spinal cord of children may cause potential brain reorganizations, affecting their rehabilitation. However, the specific functional alterations of children after complete spinal cord injury (CSCI) remain unclear. PURPOSE: To explore the specific functional changes in local brain and the relationship with clinical characteristics in pediatric CSCI patients, clarifying the impact of CSCI on brain function in developing children. STUDY TYPE Prospective. SUBJECTS: Thirty pediatric CSCI patients (7.83 ± 1.206 years) and 30 age-, gender-matched healthy children as controls (HCs) (8.77 ± 2.079 years). FIELD STRENGTH/SEQUENCE 3.0 T/Resting-state functional MRI (rs-fMRI) using echo-planar-imaging (EPI) sequence. ASSESSMENT Amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were used to characterize regional neural function. STATISTICAL TESTS Two-sample t-tests were used to compare the ALFF, fALFF, ReHo values of the brain between pediatric CSCI and HCs (voxel-level FWE correction, P < 0.05). Spearman correlation analyses were performed to analyze the associations between the ALFF, fALFF, ReHo values in altered regions and the injury duration, sensory motor scores of pediatric CSCI patients (P < 0.05). Then receiver operating characteristic (ROC) analysis was conducted to identify possible sensitive imaging indicators for clinical therapy. RESULTS: Compared with HCs, pediatric CSCI showed significantly decreased ALFF in the right postcentral gyrus (S1), orbitofrontal cortex, and left superior temporal gyrus (STG), increased ALFF in bilateral caudate nucleus, thalamus, middle cingulate gyrus, and cerebellar lobules IV-VI, and increased ReHo in left cerebellum Crus II and Brodmann area 21. The ALFF value in the right S1 negatively correlated with the pinprick and light touch sensory scores of pediatric CSCI. When the left STG was used as an imaging biomarker for pediatric CSCI, it achieved the highest area under the curve of 0.989. CONCLUSIONS: These findings may provide potential neural mechanisms for sensory motor and cognitive-emotional deficits in children after CSCI. EVIDENCE LEVEL 2 TECHNICAL EFFICACY Stage 5.