Neurite orientation dispersion and density imaging for preoperative evaluation of cerebral microstructure and neurodevelopment in children with congenital heart disease.

Background: Congenital heart disease (CHD) is a type of heart structure defect caused by the abnormal development of the heart and major blood vessels during the embryonic stage. With the continuous innovation of surgical treatment techniques and the improvement of perioperative management, the survival rate of children with CHD has significantly improved. However, accompanying central nervous system development problems have become increasingly prominent. This study investigated the clinical utility of neurite orientation dispersion and density imaging (NODDI) in evaluating preoperative cerebral microstructural features and neurodevelopmental status in children with CHD. Methods: Fifty-five infants with CHD were prospectively enrolled in the CHD group, and 55 age- and sex-comparable typically developing infants were included as the control group. All participants completed the Gesell Development Schedules assessment. The developmental quotient (DQ) and domain-specific subscale scores for five core developmental domains were recorded: adaptive behavior (AB), fine motor (FM), gross motor (GM), language (L), and personal-social behavior (PSB). Diffusion spectrum imaging (DSI) was acquired in all participants, and multiparametric NODDI maps were generated on a postprocessing workstation (Siemens Healthineers). The derived quantitative parameters included extracellular volume fraction (ECVF), neurite density index (NDI), isotropic volume fraction (ISOVF), and the orientation dispersion index (ODI). Intergroup differences in NODDI parameters and Gesell developmental scores were statistically analyzed. Pearson product-moment correlation analysis was then applied to evaluate associations between region-specific NODDI parameters and individual Gesell domain scores within the CHD group. Results: The ECVF in the splenium of the corpus callosum (SCC) of the CHD group was significantly lower than that of the control group (t=-2.261; P=0.026), whereas the ECVF in the frontal white matter (FWM) was significantly higher (t=2.242, P=0.027). ODI measurements in the posterior limb of the internal capsule (PLIC) were significantly lower in the CHD group than in the control group (t=2.401; P=0.018). Intracellular volume fraction (ICVF) values in the PLIC and SCC were also significantly higher in the CHD group (PLIC: t=4.489, P<0.001; SCC: t=2.388, P=0.019). ODI measurements in the occipital white matter (OWM) were significantly lower in the CHD group than in the control group (t=3.707; P<0.001). Compared to the control group, the CHD group had significantly lower ISOVF measurements in the PTR (t=-2.119, P=0.038), FWM (t=-2.825, P=0.006), OWM (t=-2.253; P=0.028), and temporal white matter (t=-2.164; P=0.034). Correlation analysis further showed that Gesell scores, including DQ, AB, FM, GM, L, and PSB, were consistently lower in the CHD group than in the control group. Within the CHD cohort, the NDI value of the PLIC showed a positive correlation with DQ, AB, FM, GM, L, and PSB, whereas the ODI value of the PLIC showed a positive correlation with PSB. The ISOVF value of the genu of the corpus callosum showed a positive correlation with DQ, AB, L, and PSB. The NDI value of the SCC showed a positive correlation with AB and L. Conclusions: NODDI sensitively detects preoperative cerebral microstructural changes in children with CHD, and its key parameters correlate with preoperative neurodevelopmental performance. Thus, NODDI-derived parameters may serve as candidate imaging biomarkers for evaluating brain microstructure and development before surgery, offering objective imaging-based support for early clinical assessment and timely intervention.