Resumen de Brain connectivity network models based on multi-modal MRI to study brain reorganization of prenatal origin using intrauterine growth restriction as a model
This PhD thesis is focused in the application of brain network models obtained from different modalities of magnetic resonance imaging (MRI) to characterize anomalies in neurodevelopment of a prenatal origin, using intrauterine growth restriction (IUGR) as a clinical model. Importantly, IUGR due to placental insufficiency affects 5-10% of all pregnancies and is a leading cause of fetal morbidity and mortality. The thesis is presented as a compendium of four studies published in international journals. Each of the studies is focused in the characterization of IUGR using brain networks obtained from a specific MRI modality (structural, diffusion and functional MRI) in a specific pediatric stage in the life of subjects with IUGR (neonatal, early infancy and pre-adolescence age). The first study focuses in the characterization of brain reorganization produced by IUGR at one year of age using brain networks based on a tractography obtain from diffusion MRI, using diffusion tensor imaging (DTI) approach. In this study it is demonstrated that brain network features of IUGR infants have alterations associated with an altered neurodevelopment later in life. The second study assess the viability to use a novel methodology to obtain structural brain networks based on simple anatomical MRI based on the similitude of gray matter (GM) patterns among different areas of the brain. We demonstrated alterations in infants with IUGR using this technique, and that the alterations found are also associated with neurodevelopmental problems found later in life. In the third study we used a rabbit model of IUGR to explore if the alterations in the structural brain network persist at long-term, during preadolescence. We demonstrated that indeed, there are alterations in the structural brain network organization that persist at long-term and that this alterations are associated with neurobehavioral outcomes. Finally, using normalization approaches, we observed a peculiar compensatory effect in the subjects with IUGR. In the forth study, we assessed functional brain networks of neonates with IUGR, demonstrating that this condition produces a reorganization of functional brain connectivity since such an early age, characterized by a pattern of increased co-activation and synchronization of brain regions together with a suboptimal organization when assessing normalized networks. In addition, functional brain network features were also associated to neurobehavioral alterations. Overall, our main conclusion is that IUGR condition produces structural and functional brain reorganization since early life that persists postnatally up to pre-adolescence. We hypothesize that the observed functional and structural reorganization could be a potential substrate of high risk of altered neurodevelopment in infants with IUGR, and postulate this condition as a possible brain network disorder. Importantly, the association of network features with neurobehavior and neurodevelopment since an early age opens the opportunity to further develop early image biomarkers of altered neurodevelopment, a clinical chance to improve the management of a condition that affects up to 10% of deliveries.
