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Brain Iron Alteration in Pediatric Tourette Syndrome: A Quantitative Susceptibility Mapping Study
Liping Lin1, Zhibin Ruan1, Yufen Li1
1Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Insights
Pediatric Tourette syndrome (TS) shows altered brain iron levels, with deficiency in the anterior cingulum and excess in the putamen. Iron in the left putamen correlates with tic severity, suggesting iron dysregulation in TS.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Medical Imaging
Background:
- Tourette syndrome (TS) pathogenesis involves cortico-striato-thalamo-cortical circuits.
- Iron deficiency is noted in adult TS, but pediatric iron content is understudied.
- Quantitative Susceptibility Mapping (QSM) offers a method to assess brain iron.
Purpose of the Study:
- To quantitatively assess whole-brain iron deposition in pediatric TS versus typically developing (TD) children.
- To investigate the relationship between brain iron content and tic severity in pediatric TS.
Main Methods:
- Prospective study of 50 children with TS and 50 TD controls.
- Whole-brain imaging using 3D T1 and multi-echo gradient-recalled echo sequences.
- QSM analysis with voxel-based comparisons and Pearson's correlation for tic severity.
Main Results:
- TS children showed iron deficiency in the right anterior cingulum (p<0.001).
- Increased QSM values (iron deposition) were found in the bilateral putamen of TS children (p<0.001).
- Left putamen QSM values negatively correlated with tic severity (p=0.044).
Conclusions:
- Disturbed brain iron homeostasis in specific regions is linked to pediatric TS.
- Findings support the role of iron dysregulation in TS pathogenesis via cortico-striato-thalamo-cortical circuits.
- QSM may serve as a biomarker for diagnosing and monitoring pediatric TS.
Background:
The cortico-striato-thalamo-cortical circuits play a crucial role in the pathogenesis of Tourette syndrome (TS). While iron deficiency has been reported in adult TS, the iron content in pediatric TS remains poorly understood. This study aims to quantitatively assess whole-brain iron deposition in pediatric TS compared to typically developing (TD) children using quantitative susceptibility mapping (QSM).
Methods:
In this prospective study, we recruited 50 children with a clinical diagnosis of TS and 50 age- and gender-matched TD controls. Whole-brain images were acquired using 3D T1 and multi-echo gradient-recalled echo sequences. QSM maps were generated using the STISuite toolbox. After normalizing the QSM maps to Montreal Neurological Institute space, voxel-based analysis was applied to compare between-group differences in iron content. Additionally, we evaluated the relationship between iron content and tic severity in TS children using the Pearson's correlation test.
Results:
Compared to TD children, those with TS exhibited iron deficiency in the right anterior cingulum (pFDR < 0.001). Conversely, increased QSM values were observed in the bilateral putamen of TS children (pFDR < 0.001). Notably, QSM values in the left putamen showed a significant negative correlation with tic severity (p = 0.044).
Conclusions:
Our findings suggest that disturbed brain iron homeostasis in specific regions is associated with pediatric TS. These results reinforce the importance of the cortico-striato-thalamo-cortical circuits in TS pathogenesis and highlight the potential role of iron dysregulation. Furthermore, our study demonstrates that QSM could serve as a valuable auxiliary biomarker for diagnosing and potentially monitoring pediatric TS.
