Structural Brain Characteristics And Correlation With Clinical Symptoms In Children With Co-morbid Autism And Global Developmental Delay

Objective:The purpose of this study is to investigate the structural features in children with co-morbid autism spectrum disorder(ASD)and global developmental delay(GDD)using voxel-based morphometry(VBM)and surface-based morphometry(SBM).And to analyze the correlation between structural features and the severity of clinical symptoms,with a view to providing quantifiable and objective imaging indicators to assist clinical decision-making.Methods:50 children with ASD aged 12-60 months attending the Department of Developmental Behavioural Paediatrics at the First Hospital of Jilin University from May 2021 to May 2022 were included in this study.They were divided into two groups of ASD~+GDD~+and ASD~+GDD~-respectively according to whether they had co-morbid GDD,with 25 children in each group.All participants completed the MRI3D-T1WI scan and the Autism Diagnostic Observation Schedule(ADOS)assessment.25 children aged 12-60 months with first-episode febrile convulsions and normal developmental level(typically developing,TD)who underwent 3D-T1WI scans from January 2018 to December 2022 were selected within the medical record system of the First Hospital of Jilin University and the PACS system of the Department of Radiology.Data were analyzed using VBM and SBM techniques to statistically compare grey matter volume and cortical thickness in the ASD~+GDD~+and TD groups and the ASD~+GDD~-and TD groups,to identify differential brain areas,to extract grey matter volume and cortical thickness indicators of differential brain areas,and to correlate between them and ADOS scale scores.Results:(1)The ASD~+GDD~+group showed increased gray matter volumes in specific brain regions(left superior temporal gyrus/middle temporal gyrus,right superior temporal gyrus,right middle temporal gyrus,bilateral syrinx,and left precentral gyrus)compared to the TD group(FWE corrected,P<0.001),and no brain regions with decreased gray matter volumes were identified.The ASD~+GDD~-group showed increased gray matter volumes in specific brain region(left superior temporal gyrus,left middle temporal gyrus,right temporal pole/superior temporal gyrus,left middle frontal gyrus,and right cerebellar)compared to the TD group(FWE corrected,P<0.001),and no brain regions with decreased grey matter volumes were identified.(2)The ASD~+GDD~+group showed increased cortical thickness in specific brain regions(bilateral cuneus,bilateral lingual gyrus,bilateral superior parietal cortex,right occipital cortex,right inferior parietal cortex,right middle/superior temporal gyrus,and right transverse temporal gyrus cortex)compared to the TD group(FWE corrected,P<0.001),and no brain regions with decreased cortical thickness were identified.The ASD~+GDD~-group showed increased cortical thickness in specific brain regions(bilateral insula,right superior temporal gyrus,right occipital cortex,right inferior parietal cortex,right middle temporal gyrus)compared to the TD group(FWE corrected,P<0.001),and no brain regions with decreased cortical thickness were identified.(3)Based on the above brain area alterations,we also found a positive correlation between grey matter volume in the left precentral gyrus and Restricted and Repetitive Behavior(RRB)scores in ASD~+GDD~+patients(r=0.464,P=0.019).Conclusion:(1)The presence of specific structural brain representations in ASD~+GDD~+children compared to the TD group and the correlation analysis with the ADOS scale found that the volume of some brain areas correlated with the severity of restricted and repetitive behaviors,which may be the anatomical basis for the clinical presentation of children with ASD~+GDD~+.(2)The differences in the areas of altered brain structures between ASD~+GDD~+children and ASD~+GDD~-children suggest that the pathogenesis of co-morbidities may be different and that individualized and precise treatment should be implemented for co-morbidities.