白质微结构生物标志物预测成人语后聋患者的人工耳蜗植入效果

文献信息

中文摘要

尽管人工耳蜗植入（CI）数十年来一直用于恢复感音神经性聋患者的听力，但准确预测个体预后仍然具有挑战性——尤其是在成人语后聋患者中，这一人群相对研究不足。在我们之前的工作中，我们发现，当术前语言和认知相关区域的灰质体积和皮层厚度与术前残余听力和视听能力一起考虑时，能更好地预测CI使用6个月后的言语理解。在本研究中，我们探讨了皮层下白质（WM）的术前弥散加权成像（DWI）指标是否能解释人工耳蜗适应中的个体差异并提高预测准确性。为此，我们收集了65名成人语后双侧聋患者的术前DWI以及纯听觉和视听条件下的言语表现。在植入后6个月和12个月评估CI带来的言语理解改善。全脑分析显示，左侧弓状束一个簇内的术前各向异性分数（FA）与6个月时纯听觉和视听条件下的言语感知均呈显著正相关。将弓状束簇的FA纳入我们之前研究建立的多重线性回归模型，显著提高了6个月时CI结局的预测准确性。我们还发现了右侧额枕下束和胼胝体中的FA簇，其与视听理解和中期人工耳蜗表现呈正相关。相比之下，在束重建后显示，整个纤维束的平均FA值与言语感知没有同样强的关联。值得注意的是，性别调节了多个白质簇中年龄与FA值之间的关系。这些发现强调了局部WM微结构特性在塑造CI后言语适应中的作用。识别基于WM的CI表现预测因子可能有助于临床医生预测个体结局并制定个体化康复策略，特别是对于有延迟或有限获益风险的患者。需要进一步研究来阐明区域FA变异的来源。

英文摘要

Although cochlear implantation (CI) has been used for decades to restore hearing in sensorineural deafness, accurately predicting individual outcomes remains challenging-particularly in adults with postlingual deafness, a population that has been relatively understudied. In our previous work, we showed that speech comprehension after 6 months of CI use is better predicted when preoperative grey matter volume and cortical thickness in regions supporting language and cognition are considered alongside preoperative residual hearing and audiovisual abilities. In the present study, we investigated whether preoperative diffusion-weighted imaging (DWI) metrics in subcortical white matter (WM) could account for individual variability in cochlear implant adaptation and enhance predictive accuracy. Thereto, we collected preoperative DWI and speech performance under auditory-only and audiovisual conditions in 65 adults with postlingual bilateral deafness. Improvement in speech comprehension with CI was evaluated at 6 and 12 months post-implantation. A whole-brain analysis revealed significant positive correlations between preoperative fractional anisotropy (FA) within a cluster in the left arcuate fasciculus and speech perception at 6 months in both auditory-only and audiovisual conditions. Incorporating FA from the arcuate fasciculus cluster into the multiple linear regression model developed in our previous study significantly improved prediction accuracy for CI outcomes at 6 months. We also identified FA clusters in the right inferior fronto-occipital fasciculus and the corpus callosum that showed positive relationships with audiovisual comprehension and mid-term cochlear implant performance. In contrast, mean FA values averaged across entire tracts did not show similarly strong associations with speech perception, as shown after tract reconstruction. Notably, sex modulated the relationship between age and FA values across multiple white matter clusters. These findings underscore the role of localized WM microstructural properties in shaping speech adaptation after CI. Identifying WM-based predictors of CI performance may aid clinicians in forecasting individual outcomes and tailoring rehabilitation strategies, particularly for patients at risk of delayed or limited benefit. Further research is needed to clarify the origins of regional FA variability.