Functional network connectivity changes in children with attention‐deficit hyperactivity disorder: A resting‐state fMRI study

Altered coupling relationships across resting-state functional connectivity measures in schizophrenia, bipolar disorder, and attention deficit/hyperactivity disorder

Resting-state functional connectivity (rsFC) measures have enjoyed significant success in discovering the neuropathological characteristics of schizophrenia (SZ), bipolar disorder (BD), and attention deficit/hyperactivity disorder (ADHD). However, it is unknown whether and how the spatial and temporal coupling relationships across rsFC measures would be altered in these psychiatric disorders. Here, resting-state fMRI data were obtained from a transdiagnostic sample of healthy controls (HC) and individuals with SZ, BD, and ADHD. We used Kendall's W to compute volume-wise and voxel-wise concordance across rsFC measures, followed by group comparisons. In terms of the spatial coupling, both SZ and BD individuals exhibited decreased volume-wise concordance compared with HC. Regarding the temporal coupling, SZ individuals showed decreased voxel-wise concordance in the right lateral occipital cortex relative to HC. BD individuals exhibited decreased voxel-wise concordance in the bilateral basal forebrain and bilateral superior/middle temporal gyrus compared to HC. Additionally, correlation analyses demonstrated positive associations of voxel-wise concordance in the left basal forebrain with negative symptoms including alogia and affective flattening in pooled SZ and BD individuals. Our findings of distinct patterns of spatial and temporal decoupling across rsFC measures among SZ, BD, and ADHD may provide unique insights into the neuropathological mechanisms of these psychiatric disorders.

Investigating resting-state functional connectivity changes within procedural memory network across neuropsychiatric disorders using fMRI

BACKGROUND

Cognitive networks impairments are common in neuropsychiatric disorders like Attention Deficit Hyperactivity Disorder (ADHD), bipolar disorder (BD), and schizophrenia (SZ). While previous research has focused on specific brain regions, the role of the procedural memory as a type of long-term memory to examine cognitive networks impairments in these disorders remains unclear. This study investigates alterations in resting-state functional connectivity (rs-FC) within the procedural memory network to explore brain function associated with cognitive networks in patients with these disorders.

METHODS

This study analyzed resting-state functional magnetic resonance imaging (rs-fMRI) data from 40 individuals with ADHD, 49 with BD, 50 with SZ, and 50 healthy controls (HCs). A procedural memory network was defined based on the selection of 34 regions of interest (ROIs) associated with the network in the Harvard-Oxford Cortical Structural Atlas (default atlas). Multivariate region of interest to region of interest connectivity (mRRC) was used to analyze the rs-FC between the defined network regions. Significant differences in rs-FC between patients and HCs were identified (P < 0.001).

RESULTS

ADHD patients showed increased Cereb45 l - Cereb3 r rs-FC (p = 0.000067) and decreased Cereb1 l - Cereb6 l rs-FC (p = 0.00092). BD patients exhibited increased rs-FC between multiple regions, including Claustrum r - Caudate r (p = 0.00058), subthalamic nucleus r - Pallidum l (p = 0.00060), substantia nigra l - Cereb2 l (p = 0.00082), Cereb10 r - SMA r (p = 0.00086), and Cereb9 r - SMA l (p = 0.00093) as well as decreased rs-FC in subthalamic nucleus r - Cereb6 l (p = 0.00013) and Cereb9 r - Cereb9 l (p = 0.00033). SZ patients indicated increased Caudate r- putamen l rs-FC (p = 0.00057) and decreased rs-FC in subthalamic nucleus r - Cereb6 l (p = 0.000063), and Cereb1 r - subthalamic nucleus r (p = 0.00063).

CONCLUSIONS

This study found significant alterations in rs-FC within the procedural memory network in patients with ADHD, BD, and SZ compared to HCs. These findings suggest that disrupted rs-FC within this network may related to cognitive networks impairments observed in these disorders.

CLINICAL TRIAL NUMBER

Not applicable.

Unveiling critical ADHD biomarkers in limbic system and cerebellum using a binary hypothesis testing approach

Attention deficit hyperactivity disorder (ADHD) is a common childhood developmental disorder. In recent years, pattern recognition methods have been increasingly applied to neuroimaging studies of ADHD. However, these methods often suffer from limited accuracy and interpretability, impeding their contribution to the identification of ADHD-related biomarkers. To address these limitations, we applied the amplitude of low-frequency fluctuation (ALFF) results for the limbic system and cerebellar network as input data and conducted a binary hypothesis testing framework for ADHD biomarker detection. Our study on the ADHD-200 dataset at multiple sites resulted in an average classification accuracy of 93%, indicating strong discriminative power of the input brain regions between the ADHD and control groups. Moreover, our approach identified critical brain regions, including the thalamus, hippocampal gyrus, and cerebellum Crus 2, as biomarkers. Overall, this investigation uncovered potential ADHD biomarkers in the limbic system and cerebellar network through the use of ALFF realizing highly credible results, which can provide new insights for ADHD diagnosis and treatment.

Altered neurovascular coupling in the children with attention-deficit/hyperactivity disorder: a comprehensive fMRI analysis

The coupling between resting-state cerebral blood flow (CBF) and blood oxygenation level-dependent (BOLD) signals reflects the mechanism of neurovascular coupling (NVC), which have not been illustrated in attention-deficit/hyperactivity disorder (ADHD). Fifty ADHD and 42 age- and gender-matched typically developing controls (TDs) were enrolled. The NVC imaging metrics were investigated by exploring the Pearson correlation coefficients between CBF and BOLD-derived quantitative maps (ALFF, fALFF, DCP maps). Three types of NVC metrics (CBF-ALFF, CBF-fALFF, CBF-DCP coupling) were compared between ADHD and TDs group, and the inner association between altered NVC metrics and clinical variables in ADHD group was further analyzed. Compared to TDs, ADHD showed significantly reduced whole-brain CBF-ALFF coupling (P < 0.001). Among regional level (all PFDR < 0.05), ADHD showed significantly lower CBF-ALFF coupling in bilateral thalamus, default-mode network (DMN) involving left anterior cingulate (ACG.L) and right parahippocampal gyrus (PHG.R), execution control network (ECN) involving right middle orbital frontal gyrus (ORBmid.R) and right inferior frontal triangular gyrus (IFGtriang.R), and increased CBF-ALFF coupling in attention network (AN)-related left superior temporal gyrus (STG.L) and somatosensory network (SSN))-related left rolandic operculum (ROL.L). Furthermore, increased CBF-fALFF coupling was found in the visual network (VN)-related left cuneus and negatively correlated with the concentration index of ADHD (R = - 0.299, PFDR = 0.035). Abnormal regional NVC metrics were at widespread neural networks in ADHD, mainly involved in DMN, ECN, SSN, AN, VN and bilateral thalamus. Notably, this study reinforced the insights into the neural basis and pathophysiological mechanism underlying ADHD.

Atypical local brain connectivity in pediatric autism spectrum disorder? A coordinate-based meta-analysis of regional homogeneity studies

Despite decades of massive neuroimaging research, the comprehensive characterization of short-range functional connectivity in autism spectrum disorder (ASD) remains a major challenge for scientific advances and clinical translation. From the theoretical point of view, it has been suggested a generalized local over-connectivity that would characterize ASD. This stance is known as the general local over-connectivity theory. However, there is little empirical evidence supporting such hypothesis, especially with regard to pediatric individuals with ASD (age [Formula: see text] 18 years old). To explore this issue, we performed a coordinate-based meta-analysis of regional homogeneity studies to identify significant changes of local connectivity. Our analyses revealed local functional under-connectivity patterns in the bilateral posterior cingulate cortex and superior frontal gyrus (key components of the default mode network) and in the bilateral paracentral lobule (a part of the sensorimotor network). We also performed a functional association analysis of the identified areas, whose dysfunction is clinically consistent with the well-known deficits affecting individuals with ASD. Importantly, we did not find relevant clusters of local hyper-connectivity, which is contrary to the hypothesis that ASD may be characterized by generalized local over-connectivity. If confirmed, our result will provide a valuable insight into the understanding of the complex ASD pathophysiology.

Frequency characteristics of temporal and spatial concordance among dynamic indices in inattentive and combined subtypes of attention deficit hyperactivity disorder

Numerous voxel-based resting-state functional magnetic resonance imaging (rs-fMRI) measurements have been used to characterize spontaneous brain activity in attention deficit hyperactivity disorder (ADHD). However, the practical distinctions and commonalities among these intrinsic brain activity measures remain to be fully explored, and whether the functional concordance is related to frequency is still unknown. The study included 25 ADHD, combined type (ADHD-C); 26 ADHD, inattentive type (ADHD-I); and 28 typically developing (TD) children. We calculated the voxel-wise (temporal) and volume-wise (spatial) concordance among dynamic rs-fMRI indices in the slow-5 (0.01-0.027 Hz) and slow-4 (0.027-0.073 Hz) frequency bands, respectively. The spatiotemporal concordance within the slow-4 and slow-5 bands among the ADHD-C, ADHD-I, and TD groups was compared. Although the ADHD-C and ADHD-I groups showed similar volume-wise concordance, comparison analysis revealed that compared with ADHD-C patients, ADHD-I patients exhibited decreased voxel-wise concordance in the right median cingulate and paracingulate gyrus (MCC) and right supplementary motor area (SMA) in the slow-5 band. In addition, the voxel-wise concordance was negatively correlated with the diagnostic scores of ADHD subtypes. Our results suggest that functional concordance is frequency dependent, and dynamic concordance analysis based on specific frequency bands may provide a novel approach for investigating the pathophysiological differences among ADHD subtypes.

Dynamic functional connectivity changes of resting-state brain network in attention-deficit/hyperactivity disorder

Patients with attention-deficit/hyperactivity disorder (ADHD) have shown abnormal functional connectivity and network disruptions at the whole-brain static level. However, the changes in brain networks in ADHD patients from dynamic functional connectivity (DFC) perspective have not been fully understood. Accordingly, we executed DFC analysis on resting-state fMRI data of 25 ADHD patients and 27 typically developing (TD) children. A sliding window and Pearson correlation were used to construct the dynamic brain network of all subjects. The k-means+ + clustering method was used to recognize three recurring DFC states, and finally, the mean dwell time, the fraction of time spent for each state, and graph theory metrics were quantified for further analysis. Our results showed that ADHD patients had abnormally increased mean dwell time and the fraction of time spent in state 2, which reached a significant level (p < 0.05). In addition, a weak correlation between the default mode network was associated in three states, and the positive correlations between visual network and attention network were smaller than TD in three states. Finally, the integration of each network node of ADHD in state 2 is more potent than that of TD, and the degree of node segregation is smaller than that of TD. These findings provide new evidence for the DFC study of ADHD; dynamic changes may better explain the developmental delay of ADHD and have particular significance for studying neurological mechanisms and adjuvant therapy of ADHD.

Centrality and interhemispheric coordination are related to different clinical/behavioral factors in attention deficit/hyperactivity disorder: a resting-state fMRI study

Eigenvector-Centrality (EC) has shown promising results in the field of Psychiatry, with early results also pertaining to ADHD. Parallel efforts have focused on the description of aberrant interhemispheric coordination in ADHD, as measured by Voxel-Mirrored-Homotopic-Connectivity (VMHC), with early evidence of altered Resting-State fMRI. A sample was collected from the ADHD200-NYU initiative: 86 neurotypicals and 89 participants with ADHD between 7 and 18 years old were included after quality control for motion. After preprocessing, voxel-wise EC and VMHC values between diagnostic groups were compared, and network-level values from 15 functional networks extracted. Age, ADHD severity (Connor's Parent Rating-Scale), IQ (Wechsler-Abbreviated-Scale), and right-hand dominance were correlated with EC/VMHC values in the whole sample and within groups, both at the voxel-wise and network-level. Motion was controlled by censoring time-points with Framewise-Displacement > 0.5 mm, as well as controlling for group differences in mean Framewise-Displacement values. EC was significantly higher in ADHD compared to neurotypicals in the left inferior Frontal lobe, Lingual gyri, Peri-Calcarine cortex, superior and middle Occipital lobes, right inferior Occipital lobe, right middle Temporal gyrus, Fusiform gyri, bilateral Cuneus, right Precuneus, and Cerebellum (FDR-corrected-p = 0.05). No differences were observed between groups in voxel-wise VMHC. EC was positively correlated with ADHD severity scores at the network level (at p-value < 0.01, Inattentive: Cerebellum rho = 0.273; Hyper/Impulsive: High-Visual Network rho = 0.242, Cerebellum rho = 0.273; Global Index Severity: High-Visual Network rho = 0.241, Cerebellum rho = 0.293). No differences were observed between groups for motion (p = 0.443). While EC was more related to ADHD psychopathology, VMHC was consistently and negatively correlated with age across all networks.

Reduced homotopic interhemispheric connectivity in psychiatric disorders: evidence for both transdiagnostic and disorder specific features

There is considerable interest in the significance of structural and functional connections between the two brain hemispheres in terms of both normal function and in relation to psychiatric disorders. In recent years, many studies have used voxel mirrored homotopic connectivity analysis of resting state data to investigate the importance of connectivity between homotopic regions in the brain hemispheres in a range of neuropsychiatric disorders. The current review summarizes findings from these voxel mirrored homotopic connectivity studies in individuals with autism spectrum disorder, addiction, attention deficit hyperactivity disorder, anxiety and depression disorders, and schizophrenia, as well as disorders such as Alzheimer's disease, mild cognitive impairment, epilepsy, and insomnia. Overall, other than attention deficit hyperactivity disorder, studies across psychiatric disorders report decreased homotopic resting state functional connectivity in the default mode, attention, salience, sensorimotor, social cognition, visual recognition, primary visual processing, and reward networks, which are often associated with symptom severity and/or illness onset/duration. Decreased homotopic resting state functional connectivity may therefore represent a transdiagnostic marker for general psychopathology. In terms of disorder specificity, the extensive decreases in homotopic resting state functional connectivity in autism differ markedly from attention deficit hyperactivity disorder, despite both occurring during early childhood and showing extensive co-morbidity. A pattern of more posterior than anterior regions showing reductions in schizophrenia is also distinctive. Going forward, more studies are needed to elucidate the functions of these homotopic functional connections in both health and disorder and focusing on associations with general psychopathology, and not only on disorder specific symptoms.

Local Functional Connectivity as a Parsimonious Explanation of the Main Frameworks for ADHD in Medication-Naïve Adults

Objective: Neuroimaging studies in children with ADHD indicate that their brain exhibits an atypical functional connectivity pattern characterized by increased local connectivity and decreased distant connectivity. We aim to evaluate if the local and distant distribution of functional connectivity is also altered in adult samples with ADHD who have never received medication before. Methods: We compared local and distant functional connectivity between 31 medication-naïve adults with ADHD and 31 healthy controls and tested whether this pattern was associated with symptoms severity scores. Results: ADHD sample showed increased local connectivity in the dACC and the SFG and decreased local connectivity in the PCC. Conclusion: Results parallel those obtained in children samples suggesting a deficient integration within the DMN and segregation between DMN, FPN, and VAN. These results are consistent with the three main frameworks that explain ADHD: the neurodevelopmental delay hypothesis, the DMN interference hypothesis, and multi-network models.

Assessing the relationship between maternal risk for attention deficit hyperactivity disorder and functional connectivity in their biological toddlers

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with increased risk for poor educational attainment and compromised social integration. Currently, clinical diagnosis rarely occurs before school-age, despite behavioral signs of ADHD in very early childhood. There is no known brain biomarker for ADHD risk in children ages 2-3 years-old.

METHODS

The current study aimed to investigate the functional connectivity (FC) associated with ADHD risk in 70 children aged 2.5 and 3.5 years via functional near-infrared spectroscopy (fNIRS) in bilateral frontal and parietal cortices; regions involved in attentional and goal-directed cognition. Children were instructed to passively watch videos for approximately 5 min. Risk for ADHD in each child was assessed via maternal symptoms of ADHD, and brain data was evaluated for FC.

RESULTS

Higher risk for maternal ADHD was associated with lower FC in a left-sided parieto-frontal network. Further, the interaction between sex and risk for ADHD was significant, where FC reduction in a widespread bilateral parieto-frontal network was associated with higher risk in male, but not female, participants.

CONCLUSIONS

These findings suggest functional organization differences in the parietal-frontal network in toddlers at risk for ADHD; potentially advancing the understanding of the neural mechanisms underlying the development of ADHD.

Local Functional Connectivity as a Parsimonious Explanation of the Main Frameworks for ADHD in Medication-Naïve Adults

OBJECTIVE

Neuroimaging studies in children with ADHD indicate that their brain exhibits an atypical functional connectivity pattern characterized by increased local connectivity and decreased distant connectivity. We aim to evaluate if the local and distant distribution of functional connectivity is also altered in adult samples with ADHD who have never received medication before.

METHODS

We compared local and distant functional connectivity between 31 medication-naïve adults with ADHD and 31 healthy controls and tested whether this pattern was associated with symptoms severity scores.

RESULTS

ADHD sample showed increased local connectivity in the dACC and the SFG and decreased local connectivity in the PCC.

CONCLUSION

Results parallel those obtained in children samples suggesting a deficient integration within the DMN and segregation between DMN, FPN, and VAN. These results are consistent with the three main frameworks that explain ADHD: the neurodevelopmental delay hypothesis, the DMN interference hypothesis and multi-network models.

Genetic mechanisms underlying brain functional homotopy: a combined transcriptome and resting-state functional MRI study

Functional homotopy, the high degree of spontaneous activity synchrony and functional coactivation between geometrically corresponding interhemispheric regions, is a fundamental characteristic of the intrinsic functional architecture of the brain. However, little is known about the genetic mechanisms underlying functional homotopy. Resting-state functional magnetic resonance imaging data from a discovery dataset (656 healthy subjects) and 2 independent cross-race, cross-scanner validation datasets (103 and 329 healthy subjects) were used to calculate voxel-mirrored homotopic connectivity (VMHC) indexing brain functional homotopy. In combination with the Allen Human Brain Atlas, transcriptome-neuroimaging spatial correlation analysis was conducted to identify genes linked to VMHC. We found 1,001 genes whose expression measures were spatially associated with VMHC. Functional enrichment analyses demonstrated that these VMHC-related genes were enriched for biological functions including protein kinase activity, ion channel regulation, and synaptic function as well as many neuropsychiatric disorders. Concurrently, specific expression analyses showed that these genes were specifically expressed in the brain tissue, in neurons and immune cells, and during nearly all developmental periods. In addition, the VMHC-associated genes were linked to multiple behavioral domains, including vision, execution, and attention. Our findings suggest that interhemispheric communication and coordination involve a complex interaction of polygenes with a rich range of functional features.

Effects of the SNAP25 on Integration Ability of Brain Functions in Children With ADHD

OBJECTIVE

The present study aimed to examine the effects of SNAP25 on the integration ability of intrinsic brain functions in children with ADHD, and whether the integration ability was associated with working memory (WM).

METHODS

A sliding time window method was used to calculate the spatial and temporal concordance among five rs-fMRI regional indices in 55 children with ADHD and 20 healthy controls.

RESULTS

The SNAP25 exhibited significant interaction effects with ADHD diagnosis on the voxel-wise concordance in the right posterior central gyrus, fusiform gyrus and lingual gyrus. Specifically, for children with ADHD, G-carriers showed increased voxel-wise concordance in comparison to TT homozygotes in the right precentral gyrus, superior frontal gyrus, postcentral gyrus, and middle frontal gyrus. The voxel-wise concordance was also found to be related to WM.

CONCLUSION

Our findings provided a new insight into the neural mechanisms of the brain function of ADHD children.

The colors of our brain: an integrated approach for dimensionality reduction and explainability in fMRI through color coding (i-ECO)

Several systematic reviews have highlighted the role of multiple sources in the investigation of psychiatric illness. For what concerns fMRI, the focus of recent literature preferentially lies on three lines of research, namely: functional connectivity, network analysis and spectral analysis. Data was gathered from the UCLA Consortium for Neuropsychiatric Phenomics. The sample was composed by 130 neurotypicals, 50 participants diagnosed with Schizophrenia, 49 with Bipolar disorder and 43 with ADHD. Single fMRI scans were reduced in their dimensionality by a novel method (i-ECO) averaging results per Region of Interest and through an additive color method (RGB): local connectivity values (Regional Homogeneity), network centrality measures (Eigenvector Centrality), spectral dimensions (fractional Amplitude of Low-Frequency Fluctuations). Average images per diagnostic group were plotted and described. The discriminative power of this novel method for visualizing and analyzing fMRI results in an integrative manner was explored through the usage of convolutional neural networks. The new methodology of i-ECO showed between-groups differences that could be easily appreciated by the human eye. The precision-recall Area Under the Curve (PR-AUC) of our models was > 84.5% for each diagnostic group as evaluated on the test-set – 80/20 split. In conclusion, this study provides evidence for an integrative and easy-to-understand approach in the analysis and visualization of fMRI results. A high discriminative power for psychiatric conditions was reached. This proof-of-work study may serve to investigate further developments over more extensive datasets covering a wider range of psychiatric diagnoses.

Altered Variability and Concordance of Dynamic Resting-State fMRI Indices in Patients With Attention Deficit Hyperactivity Disorder

Objective: Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed neuropsychiatric disorder in children, which is characterized by inattention, hyperactivity and impulsivity. Using resting-state functional magnetic resonance imaging (R-fMRI), the alterations of static and dynamic characteristics of intrinsic brain activity have been identified in patients with ADHD. Yet, it remains unclear whether the concordance among indices of dynamic R-fMRI is altered in ADHD. Methods: R-fMRI scans obtained from 50 patients with ADHD and 28 healthy controls (HC) were used for the current study. We calculated the regional dynamic changes in brain activity indices using the sliding-window method and compared the differences in variability of these indices between ADHD patients and HCs. Further, the concordance among these dynamic indices was calculated and compared. Finally, the relationship between variability/concordance of these indices and ADHD-relevant clinical test scores was investigated. Results: Patients with ADHD showed decreased variability of dynamic amplitude of low-frequency fluctuation (dALFF) in the left middle frontal gyrus and increased one in right middle occipital gyrus, as compared with the HCs. Besides, ADHD patients showed decreased voxel-wise concordance in the left middle frontal gyrus. Further, lower voxel-wise concordance in ADHD's left middle frontal gyrus was associated with more non-perseverative errors in Wisconsin Card Sorting Test, which reflects worse cognitive control. Conclusion: Our findings suggest that variability and concordance in dynamic brain activity may serve as biomarkers for the diagnosis of ADHD. Further, the decreased voxel-wise concordance is associated with deficit in cognitive control in ADHD patients.

Different effects of the DRD4 genotype on intrinsic brain network connectivity strength in drug-naïve children with ADHD and healthy controls

The dopamine D4 receptor gene (DRD4) has been consistently reported to be associated with attention-deficit/hyperactivity disorder (ADHD). Recent studies have linked DRD4 to functional connectivity among specific brain regions. The current study aimed to compare the effects of the DRD4 genotype on functional integrity in drug-naïve ADHD children and healthy children. Resting-state functional MRI images were acquired from 49 children with ADHD and 37 healthy controls (HCs). We investigated the effects of the 2-repeat allele of DRD4 on brain network connectivity in both groups using a parameter called the degree of centrality (DC), which indexes local functional relationships across the entire brain connectome. A voxel-wise two-way ANCOVA was performed to examine the diagnosis-by-genotype interactions on DC maps. Significant diagnosis-by-genotype interactions with DC were found in the temporal lobe, including the left inferior temporal gyrus (ITG) and bilateral middle temporal gyrus (MTG) (GRF corrected at voxel level p < 0.001 and cluster level p < 0.05, two-tailed). With the further subdivision of the DC network according to anatomical distance, additional brain regions with significant interactions were found in the long-range DC network, including the left superior parietal gyrus (SPG) and right middle frontal gyrus (MFG). The post-hoc pairwise analysis found that altered network centrality related to DRD4 differed according to diagnostic status (p < 0.05). This genetic imaging study suggests that the DRD4 genotype regulates the functional integration of brain networks in children with ADHD and HCs differently. This may have important implications for our understanding of the role of DRD4 in altering functional connectivity in ADHD subjects.

Neuroimaging in Attention-Deficit/Hyperactivity Disorder: Recent Advances

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition, leading to impaired attention and impulsive behaviors diagnosed in, but not limited to, children. ADHD can cause symptoms throughout life. This article summarizes structural (conventional, volumetric, and diffusion tensor imaging MRI) and functional [task-based functional MRI (fMRI), resting state fMRI, PET, and MR spectroscopy] brain findings in patients with ADHD. Consensus is lacking regarding altered anatomic or functional imaging findings of the brain in children with ADHD, likely because of the disorder's heterogeneity. Most anatomic studies report abnormalities in the frontal lobes, basal ganglia, and corpus callosum; decreased surface area in the left ventral frontal and right prefrontal cortex; thinner medial temporal lobes; and smaller caudate nuclei. Using fMRI, researchers have focused on the prefrontal and temporal regions, reflecting perception-action mapping alterations. Artificial intelligence models evaluating brain anatomy have highlighted changes in cortical thickness and shape of the inferior frontal cortex, bilateral sensorimotor cortex, left temporal lobe, and insula. Early intervention and/or normal brain maturation can alter imaging patterns and convert functional imaging studies to a normal pattern. While the imaging findings provide insight into the disease's neuropathophysiology, no definitive structural or functional pattern defines the disorder from a neuroradiologic perspective.

Aberrant prefrontal cortical-striatal functional connectivity in children with primary complex motor stereotypies

Motor stereotypies are rhythmic, repetitive, prolonged, predictable, and purposeless movements that stop with distraction. Although once believed to occur only in children with neurodevelopmental disorders such as autism, the presence and persistence of complex motor stereotypies (CMS) in otherwise typically developing children (primary CMS) has been well-established. Little, however, is known about the underlying pathophysiology of these unwanted actions. The aim of the present study was to use resting-state functional magnetic resonance imaging to evaluate functional connectivity within frontal-striatal circuits that are essential for goal-directed and habitual activity in children with primary complex motor stereotypies. Functional connectivity between prefrontal cortical and striatal regions, considered essential for developing goal-directed behaviors, was reduced in children with primary CMS compared to their typically developing peers. In contrast, functional connectivity between motor/premotor and striatal regions, critical for developing and regulating habitual behaviors, did not differ between groups. This documented alteration of prefrontal to striatal connectivity could provide the underlying mechanism for the presence and persistence of complex motor stereotypies in otherwise developmentally normal children.

Aberrant brain voxel-wise resting state fMRI in patients with thyroid-associated ophthalmopathy

BACKGROUND AND PURPOSE

Although ophthalmic complaints were mostly mentioned in thyroid-associated ophthalmopathy (TAO), emotional and psychological disturbances are increasingly concerned. We aimed to investigate the brain functional alteration in TAO patients by using resting-state functional MRI (rs-fMRI) with the fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree centrality (DC) methods.

METHODS

Twenty-one consecutive TAO patients and 21 healthy controls (HCs) underwent rs-fMRI scans. The fALFF, ReHo, and DC values were compared between groups.

RESULTS

Compared with HCs, TAO group showed decreased fALFF values in bilateral calcarine/left lingual gyrus and left middle occipital gyrus (MOG). Moreover, TAO group had decreased ReHo values in left MOG/inferior occipital gyrus/fusiform gyrus, while increased ReHo values in bilateral middle frontal gyrus (MFG)/superior frontal gyrus (SFG) than HCs. TAO group also showed decreased DC values in bilateral postcentral gyrus (PoCG)/precentral gyrus/superior parietal lobule and supplementary motor area, and increased DC values in left SFG/MFG and MFG. In TAO patients, ReHo value in left MOG was positively correlated with visual acuity (r = 0.524, p = 0.021), while ReHo values in bilateral MFGs were negatively correlated with cognitive scores (left/right: r = -0.476/-0.527, p = 0.039/0.020). DC value in left PoCG was negatively correlated with disease duration (r = -0.492, p = 0.033).

CONCLUSIONS

Our findings indicated that TAO patients had brain functional alterations in the visual network, executive control network, sensorimotor network, and attention network, which may reflect potential visual and cognitive dysfunctions.

Reduced Inter-hemispheric Resting State Functional Connectivity and Its Association With Social Deficits in Autism

Autism spectrum disorder (ASD) is an early onset developmental disorder which persists throughout life and is increasing in prevalence over the last few decades. Given its early onset and variable cognitive and emotional functional impairments, it is generally challenging to assess ASD individuals using task-based behavioral and functional MRI paradigms. Consequently, resting state functional MRI (rs-fMRI) has become a key approach for examining ASD-associated neural alterations and revealed functional alterations in large-scale brain networks relative to typically developing (TD) individuals, particularly those involved in social-cognitive and affective processes. Recent progress suggests that alterations in inter-hemispheric resting state functional connectivity (rsFC) between regions in the 2 brain hemispheres, particularly homotopic ones, may be of great importance. Here we have reviewed neuroimaging studies examining inter-hemispheric rsFC abnormities in ASD and its associations with symptom severity. As an index of inter-hemispheric functional connectivity, we have additionally reviewed previous studies on corpus callosum (CC) volumetric and fiber changes in ASD. There are converging findings on reduced inter-hemispheric (including homotopic) rsFC in large-scale brain networks particularly in posterior hubs of the default mode network, reduced volumes in the anterior and posterior CC, and on decreased FA and increased MD or RD across CC subregions. Associations between the strength of inter-hemispheric rsFC and social impairments in ASD together with their classification performance in distinguishing ASD subjects from TD controls across ages suggest that the strength of inter-hemispheric rsFC may be a more promising biomarker for assisting in ASD diagnosis than abnormalities in either brain wide rsFC or brain structure.

Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition

INTRODUCTION

Non-central nervous system cancer in childhood (non-CNS CC) and its treatments pose a major threat to brain development, with implications for functional networks. Structural and functional alterations might underlie the cognitive late-effects identified in survivors of non-CNS CC. The present study evaluated resting-state functional networks and their associations with cognition in a mixed sample of non-CNS CC survivors (i.e., leukemia, lymphoma, and other non-CNS solid tumors).

METHODS

Forty-three patients (off-therapy for at least 1 year and aged 7-16 years) were compared with 43 healthy controls matched for age and sex. High-resolution T1-weighted structural magnetic resonance and resting-state functional magnetic resonance imaging were acquired. Executive functions, attention, processing speed, and memory were assessed outside the scanner.

RESULTS

Cognitive performance was within the normal range for both groups; however, patients after CNS-directed therapy showed lower executive functions than controls. Seed-based connectivity analyses revealed that patients exhibited stronger functional connectivity between fronto- and temporo-parietal pathways and weaker connectivity between parietal-cerebellar and temporal-occipital pathways in the right hemisphere than controls. Functional hyperconnectivity was related to weaker memory performance in the patients' group.

CONCLUSION

These data suggest that even in the absence of brain tumors, non-CNS CC and its treatment can lead to persistent cerebral alterations in resting-state network connectivity.

Resting-state abnormalities of posterior cingulate in autism spectrum disorder

The posterior cingulate cortex (PCC) plays pivotal roles in cognitive, social and emotional processing, as well as early neural development that supports complex interactions among different neural networks. Alterations in its local and long-range connectivity during resting state are often implicated in neuropathology of neurodevelopmental disorders such as autism spectrum disorder (ASD). ASD is characterized by social and communication deficits, as well as restricted and repetitive behaviors and interests. Individuals with ASD demonstrate persistent disturbances in cognitive and social-emotional functioning, and their PCC exhibits both local and long-range resting state abnormalities compared to typically developing healthy controls. In terms of regional metrics, only the dorsal part of the PCC showed local underconnectivity. As to long-range connectivity measures, the most replicated finding in ASD studies is the reduced functional coupling between the PCC and medial prefrontal cortex (MPFC), which may represent a core neuropathology of ASD unrelated to medication effects. Functional importance of these resting state abnormalities to ASD and directions of future study are discussed at the end of this chapter.

Influence of Gonadotropin Hormone Releasing Hormone Agonists on Interhemispheric Functional Connectivity in Girls With Idiopathic Central Precocious Puberty

Purpose: The pubertal growth suppressive effects of gonadotropin hormone releasing hormone agonists (GnRHa) are well-known, although it remains unclear if long-term GnRHa treatment influences the brain function of treated children. The present study investigated the differences in the homotopic resting-state functional connectivity patterns in girls with idiopathic central precocious puberty (ICPP) with and without GnRHa treatment using voxel-mirrored homotopic connectivity (VMHC).

Methods: Eighteen girls with ICPP who underwent 12 months of GnRHa treatment, 40 treatment-naïve girls with ICPP, and 19 age-matched girls with premature thelarche underwent resting-state functional magnetic resonance imaging using a 3T MRI. VMHC method was performed to explore the differences in the resting-state interhemispheric functional connectivity. The levels of serum pubertal hormones, including luteinizing hormone (LH), follicular-stimulating hormone, and estradiol, were assessed. Correlation analyses among the results of clinical laboratory examinations, neuropsychological scales, and VMHC values of different brain regions were performed with the data of the GnRHa treated group.

Results: Significant decreases in VMHC of the lingual, calcarine, superior temporal, and middle frontal gyri were identified in the untreated group, compared with the control group. Medicated patients showed decreased VMHC in the superior temporal gyrus, when compared with the controls. Compared to the unmedicated group, the medicated group showed a significant increase in VMHC in the calcarine and middle occipital gyrus. Moreover, a positive correlation was observed between basal LH levels and VMHC of the middle occipital gyrus in medicated patients.

Conclusions: These findings indicate that long-term treatment with GnRHa was associated with increased interhemispheric functional connectivity within several areas responsible for memory and visual process in patients with ICPP. Higher interhemispheric functional connectivity in the middle occipital gyrus was related to higher basal LH production in the girls who underwent treatment. The present study adds to the growing body of research associated with the effects of GnRHa on brain function.

Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning: a resting-state fMRI study

Purpose

To explore neuropathologic mechanisms in functional brain regions in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP) from the perspective of the brain network nodes by resting-state functional magnetic resonance imaging (rs-fMRI).

Methods

The fMRI and cognitive assessments were performed in 25 patients with DEACMP and 25 age-, sex- and education-matched healthy controls (HCs). Data analysis was performed via the degree centrality (DC) method. Then, the associations between the cognitive assessments and DC in the identified abnormal brain regions were assessed by using a correlation analysis.

Results

Compared with the HCs, the DEACMP patients displayed significantly decreased DC values in the right superior frontal gyrus, right precentral gyrus, right angular gyrus, right marginal gyrus, right hippocampus, and left thalamus but increased DC values in the right inferior frontal gyrus, right cingulate gyrus, left superior temporal gyrus, left medial temporal gyrus, right lingual gyrus, and right posterior cerebellar lobe, pons, and midbrain (GRF correction, voxel P value < 0.001, cluster P value < 0.01). The correlation analysis in the DEACMP group revealed that there was a negative correlation between the DC values in the right hippocampus and MMSE scores, whereas a positive correlation was observed in the right cingulate gyrus.

Conclusions

Patients with DEACMP exhibited abnormal degree centrality in the brain network. This finding may provide a new approach for examining the neuropathologic mechanisms underlying DEACMP.