What is the Functional Difference Between Sagittal with Metopic and Isolated Sagittal Craniosynotosis?
Raysa Cabrejo1, Cheryl Lacadie, BS1, Carolyn Chuang, MD1, Jenny Yang, MD1, Alex Sun, MD1, Eric Brooks, MD1, Joel Beckett, MD1, Kyle Gabrick, MD1, Derek Steinbacher, MD, DMD1, Michael Alperovich, MD, MSc1, Kevin Pelphrey, PhD2, Todd Constable, PhD1, John Persing, MD1.
1Yale Medical School, New Haven, CT, USA, 2George Washington University, Washington DC, DC, USA.
Purpose:
The purpose of this study is to understand the neurological differences between patients born with combined sagittal and metopic craniosynostosis (SMc) and isolated sagittal craniosynostosis (ISc) by studying aberrations in functional brain connectivity and white matter microstructure before surgery utilizing functional MRI (fMRI) and diffusion tension imaging (DTI).
Methods:
The authors collected DTI and resting-state (i.e. no sedation and asleep) functional connectivity MRI data in ten infant patients pre-operatively: five in the SMc group (4.3±1 months) and five in the ISc group (4.8±1.1 months). Resting state fMRI imaging and DTI data were acquired using a 3-T Siemens Trio MRI system (Erlangen, Germany) while the infant patients slept. fMRI data was corrected for movement using SPM (University College London, UK), underwent CSF and WM signal regression and further analyzed with BioImageSuite (Yale University, USA). For the DTI data, three diffusions run were averaged, processed utilizing FMRIB Software Library (Oxford University, UK), and analyzed statistically using BioImageSuite (Yale University, USA).
Results:
Comparing the SMc vs ISc groups, SMc demonstrated that there was increased connectivity, statistically significant differences in neural networks between children with sagittal synostosis alone versus those with sagittal with metopic synostosis, in the right BA 31 and BA 23 corresponding to the posterior cingulate cortex (p<0.001). Analysis of the DTI revealed increased fractional anisotropy in the SMc group in the cingulum compared to the ISc group (p<0.05). Differences in the functional networks include increased connectivity right frontoparietal network (RFPN) in ISc and increased connectivity in the primary visual network (V1) in SMc (p<0.001).
Conclusion:
The SMc had increased connectivity as measured by fMR in the in the posterior cingulate cortex, an area associated with attention deficit hyperactivity disorder (ADHD). The DTI analysis demonstrated an increased in fractional anisotropy in SMc group in the cingulum, a white matter tract projecting from the cingulate cortex, instrumental in the connections of the limbic (emotional regulation) system. In SMc, increase in connectivity of the PCC correlates with an increase in maturation of the cingulum compared to ISc. The SMc group has increased connectivity in the PCC, the original seed of the DMN network, and decreased connectivity to the RFPN network. This is a similar footprint to ADHD, which has increased connectivity in the DMN and decreased connectivity in the RFPN. SMc has more similar functional network connectivity to ADHD when compared to ISc.
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