Specific Alterations in Brain White Matter Networks and Their Impact on Clinical Function in Pediatric Patients With Thoracolumbar Spinal Cord Injury

Background: The alternation of brain white matter (WM) network has been studied in adult spinal cord injury (SCI) patients. However, the WM network alterations in pediatric SCI patients remain unclear.Purpose: To evaluate WM network changes and their functional impact in children with thoracolumbar SCI (TSCI).Study Type: Prospective.Subjects: Thirty-five pediatric patients with TSCI (8.94 +/- 1.86 years, 8/27 males/females) and 34 age- and gender-matched healthy controls (HCs) participated in this study.Field Strength/Sequence3.0 T/DTI imaging using spin-echo echo-planar and T1-weighted imaging using 3D T1-weighted magnetization-prepared rapid gradient-echo sequence.Assessment: Pediatric SCI patients were evaluated for motor and sensory scores, injury level, time since injury, and age at injury. The WM network was constructed using a continuous tracing method, resulting in a 90 x 90 matrix. The global and regional metrics were obtained to investigate the alterations of the WM structural network. topology.Statistical Tests: Two-sample independent t-tests, chi-squared test, Mann-Whitney U-test, and Spearman correlation. Statistical significance was set at P < 0.05.Results: Compared with HCs, pediatric TSCI patients displayed decreased shortest path length (L-p = 1.080 +/- 0.130) and normalized L-p (lambda = 5.020 +/- 0.363), and increased global efficiency (E-g = 0.200 +/- 0.015). Notably, these patients also demonstrated heightened regional properties in the orbitofrontal cortex, limbic system, default mode network, and several audio-visual-related regions. Moreover, the lambda and L-p values negatively correlated with sensory scores. Conversely, nodal efficiency values in the right calcarine fissure and surrounding cortex positively correlated with sensory scores. The age at injury positively correlated with node degree in the left parahippocampal gyrus and nodal efficiency in the right posterior cingulate gyrus.Data Conclusion: Reorganization of the WM networks in pediatric SCI patients is indicated by increased global and nodal efficiency, which may provide promising neuroimaging biomarkers for functional assessment of pediatric SCI.