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Age-related change of glymphatic function in normative children assessed using diffusion tensor imaging-analysis
Alex Mun-Ching Wong1, Tiing-Yee Siow1, Yi-Ting Cheng2
1Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Insights
Glymphatic function, measured by DTI-ALPS, significantly increases with age in children, showing a developmental trajectory. This brain waste clearance system is bilaterally symmetrical throughout childhood.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Biomedical Engineering
Background:
- The glymphatic system is vital for brain homeostasis and waste clearance.
- Its developmental changes in children are not well understood.
- Diffusion Tensor Imaging-Analysis along the Perivascular Space (DTI-ALPS) offers a method to assess glymphatic function.
Purpose of the Study:
- To investigate the developmental trajectory of glymphatic system function in children.
- To correlate glymphatic function with age in a pediatric cohort.
- To assess the symmetry of glymphatic function in children.
Main Methods:
- Retrospective analysis of DTI MR images from 72 pediatric participants (0-19.8 years).
- Utilized 3T scanners and DTI sequences to compute the ALPS index.
- Correlated ALPS indices with age and clinical outcomes using Pearson correlation and regression.
Main Results:
- Significant positive correlations were found between age and both left and right DTI-ALPS indices (P < 0.001).
- Age was a significant predictor of DTI-ALPS indices, indicating a developmental increase in function.
- No significant differences were observed between left and right DTI-ALPS indices, suggesting bilateral symmetry.
Conclusions:
- Glymphatic system function shows significant developmental changes during childhood.
- An age-related increase in glymphatic function was observed.
- The glymphatic system demonstrates bilateral symmetry in children.
Background:
The glymphatic system, crucial for brain waste removal and homeostasis, has an underexplored developmental trajectory in children. This study describes changes in glymphatic function during childhood via diffusion tensor imaging-analysis along the perivascular space (DTI-ALPS).
Methods:
We retrospectively studied DTI MR images of 72 pediatric participants (mean age = 92.37 months; 0-19.8 years; 50 % females), all showing normal MRI findings from 2019 to 2022. Imaging utilized 3 T scanners with a DTI sequence of 21 diffusion-encoded gradients, focusing on the ALPS index to assess glymphatic function. Clinical outcomes were determined using the Pediatric Cerebral Performance Category Scale and medical records within two weeks post-MRI. Regions-of-interest on diffusion maps were selected manually, guided by fractional anisotropy maps, for automatic ALPS computation. Pearson correlation and multiple linear regression analyzed the relationship between ALPS indices, age, and clinical scores, with a paired t-test comparing bilateral ALPS indices. Significance was set at P < 0.05.
Results:
Significant positive correlations between age and both left (R = 0.510, P < 0.001) and right (R = 0.688, P < 0.001) DTI-ALPS indices were observed, indicating developmental changes in glymphatic function. Age alone significantly predicted the DTI-ALPS indices (left ALPS: adjusted R2 = 0.235; right ALPS: adjusted R2 = 0.460), underscoring its developmental trajectory. The study found no significant differences between left and right DTI-ALPS indices, suggesting symmetrical glymphatic function during childhood.
Conclusion:
This study reveals developmental changes in the glymphatic system across childhood, demonstrating an age-related increase in glymphatic function and bilateral symmetry.
