Abstract 14655: Diffusion Neuroimaging of Adults With D-Transposition of the Great Arteries Reveal White Matter Alterations in the Connectomic Rich Club
Introduction: The population of adults with d-transposition of the great arteries (TGA) continue to grow. As this group has underlying neurocognitive impairment and longer-term neurovascular damage, advanced neuroimaging to identify markers for treatment is required. Diffusion (d)MRI tractography quantifies the structural integrity of white matter (WM) pathways in the brain - where lower FA (fractional anisotropy) and higher ADC (apparent diffusion coefficient) typify WM damage. The brain’s structural backbone is its rich club (RC), a set of highly interconnected regions established before birth and vital for effective cognitive function. Moreover, there are Feeder and Seeder subnetworks peripheral to the RC, which are thought to form later and may be more adaptive. Hypothesis: We hypothesize that adults with TGA have alterations in both the brain’s structural RC and in peripheral connections. Methods: Subjects were TGA adults from the Boston Circulatory Arrest Study (n = 25, mean age 28.46 ± 1.14yr) and Controls (n = 13, 28.35 ± 1.70). Multi-shell, high-angular resolution dMRI data were acquired and fitted with a multi-fiber model (Fig). After tractography, a connectome of the number of tracts connecting pairwise cortical regions was computed. A priori RC regions were bilateral superior frontal and parietal frontal gyri, precuneus, posterior cingulate and insular regions. Connections were grouped into subnetworks and mean FA and ADC computed. Results: Cohorts were age-matched (p=0.801, unpaired t-test). Overall, patients had lower FA and greater ADC than controls in all subnetworks. Group differences (unpaired t-tests) were significant in the RC (ADC p=0.029), Feeder subnetwork (FA p=0.041; ADC p=0.042), with trends in Seeder subnetworks (FA p=0.061; ADC p=0.062). Conclusions: Widespread WM alterations exist in adults with TGA not only in the brain’s most central system, but also connections feeding into the RC suggesting prenatal and adaptive changes.