Diffusion Tensor Imaging for Evaluating Glymphatic System Function in Neonates with Complex Congenital Heart Disease

Motivation: Given the strong link between cardiovascular and glymphatic systems, we investigated the DTI-ALPS index, a non-invasive measure of perivascular diffusion, as a biomarker of neurodevelopment in neonates with complex congenital heart disease (CHD). Goal(s): To measure the DTI-ALPS index in healthy neonates and neonates with complex CHD before and after surgery. Approach: We calculated the DTI-ALPS index, adjusting for gestational age at birth, in 182 healthy newborns and 120 CHD cases with pre- and post-operative DTI scans. Results: CHD neonates demonstrated a lower DTI-ALPS index than controls. Interestingly, cases with transposition of the great arteries (TGA) showed further reduction of DTI-ALPS index post-surgery. Impact: Assessing glymphatic system function (GSF) in newborns is challenging due to the need for contrast agents. However, this study demonstrates that the DTI-ALPs index holds promise as a non-invasive biomarker for GSF in high-risk neonates such as those with CHD.