DO PEDIATRIC INDIVIDUALS WITH ADENOID HYPERTROPHY HAVE DEVELOPMENTAL DIFFERENCES IN BRAIN ANATOMICAL STRUCTURES? A RETROSPECTIVE MAGNETIC RESONANCE IMAGING STUDY
Yıl 2025,
Cilt: 6 Sayı: 3
,
118
-
124
,
30.12.2025
Sefa Işıklar
,
Dilek Sağlam
Öz
Objective: Adenoid hypertrophy (AH) can cause changes in the brain by causing sleep-disordered breathing and obstructive sleep apnea. However, it has not been investigated whether AH affects the brain anatomy as a single factor independent of these diseases. In this study, we investigated the effects of AH on brain development using the estimated brain age (EBA) method.
Method: This retrospective study included 55 individuals (39 males) with AH, aged 1-12 years, and 55 individuals of similar age and sex without AH. We used the adenoid-nasopharyngeal ratio (ANR: ratio of adenoid thickness to nasopharynx width) to detect AH. We used volBrain's BrainStructureAges (BSA) pipeline for EBA on brain anatomical structures. We compared the data with SPSS (ver.28).
Results: ANR were higher in AH group (0.66±0.06) than control group (0.40±0.09) (p<0.05). Since the mean ANO value was between 0.60 and 0.69, AH group had mild obstruction. The mean chronological age of children in this study's AH and control groups was 5.07±2.80 years. We did not detect any significant difference in the global brain mean EBA values between the AH group (6.85±3.18 years) and the control group (6.97±3.30 years) (p>0.05). Mean EBA values of cortical and subcortical anatomical regions ranged from 6.51 to 7.97 years in the AH group and from 6.56 to 8.22 years in the control group. There was no statistically significant difference in EBA values of brain regions between AH and control groups (p>0.05).
Conclusion: This study showed that mild AH does not negatively affect children's brain development in terms of EBA. Although minor deviations in EBA were observed in selected cortical and subcortical regions, these variations remained within the normal range of developmental heterogeneity. These findings demonstrated that mild AH is not an independent risk factor for brain development in the pediatric population.
Kaynakça
-
van Cauwenberge PB, Bellussi L, Richard Maw A, Paradise JL, Solow B. The adenoid as a key factor in upper airway infections. Int J Pediatr Otorhinolaryngol.1995;32:S71-S80.
-
Boyaka PN, Wright PF, Marinaro M, et al. Human nasopharyngeal-associated lymphoreticular tissues: functional analysis of subepithelial and ıntraepithelial b and t cells from adenoids and tonsils. Am J Pathol. 2000;157:2023-2035.
-
Meyer W, Marshall J. On adenoid vegetations in the naso-pharyngeal cavity: their pathology, diagnosis, and treatment. Med Chir Trans. 1870;53:191-216.
-
Hu Z, Dong J, Lou M, et al. Effect of different degrees of adenoid hypertrophy on pediatric upper airway aerodynamics: a computational fluid dynamics study. Biomech Model Mechanobiol. 2023;22:1163-1175.
-
Greenfeld M, Tauman R, DeRowe A, Sivan Y. Obstructive sleep apnea syndrome due to adenotonsillar hypertrophy in infants. Int J Pediatr Otorhinolaryngol. 2003;67:1055-1060.
-
Chi L, Comyn FL, Mitra N, et al. Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI. Eur Respir J. 2011;38:348-358.
-
Philby MF, Macey PM, Ma RA, Kumar R, Gozal D, Kheirandish-Gozal L. Reduced regional grey matter volumes in pediatric obstructive sleep apnea. Sci Rep. 2017;7:44566.
-
Eun YJ, Woo ST, Sun JH, Cho JW, Seung BH. Reduced cerebral blood flow during wakefulness ın obstructive sleep apnea-hypopnea syndrome. Sleep. 2007;30:1515-1520.
-
Bålfors EM, Franklin KA. Impairment of cerebral perfusion during obstructive sleep apneas. Am J Respir Crit Care Med. 1994;150:1587-1591.
-
Tan HL, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: A critical update. Nat Sci Sleep. 2013;5:109-123.
-
Rosenzweig I, Glasser M, Polsek D, Leschziner GD, Williams SCR, Morrell MJ. Sleep apnoea and the brain: a complex relationship. Lancet Respir Med. 2015;3:404-414.
-
Thabit MN, Elnady HM, Badawy BS, Mahmoud HA. Cognitive event-related potentials in patients with adenoid hypertrophy: A case-control pilot study. J Clin Neurophysiol. 2016;33:443-449.
-
Kurnatowski P, Putyński L, Łapienis M, Kowalska B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2006;70:419-424.
-
Ma Y, Niu Z, Ruan L, et al. Alterations in amygdala/hippocampal volume ratios in children with obstructive sleep apnea syndrome caused by adenotonsillar hypertrophy. Med Sci Monit. 2023;29:e937420.
-
Kheirandish-Gozal L, Sahib AK, Macey PM, Philby MF, Gozal D, Kumar R. Regional brain tissue integrity in pediatric obstructive sleep apnea. Neurosci Lett. 2018;682:118-123.
-
Brooks LJ, Stephens BM, Bacevice AM. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr. 1998;132:682-686.
-
Nguyen HD, Clément M, Mansencal B, Coupé P. Brain structure ages-a new biomarker for multi-disease classification. Hum Brain Mapp. 2024;45:e26558.
-
Capitanio MA, Kirkpatrick JA. Nasopharyngeal lymphoid tissue. Roentgen observations in 257 children two years of age or less. Radiology.1970;96:389-391.
-
Fedorov A, Beichel R, Kalpathy-Cramer J, et al. 3D Slicer as an image computing platform for the quantitative ımaging network. Magn Reson Imaging. 2012;30:1323-1341.
-
Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. Am J Roentgenol. 1979;133:401-404.
-
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods. 2007;39(2):175-191.
-
Cohen J. Statistical power analysis for the behavioral sciences. Stat Power Anal Behav Sci. 2013.
-
Surov A, Ryl I, Bartel-Friedrich S, Wienke A, Kösling S. MRI of nasopharyngeal adenoid hypertrophy. Neuroradiol J. 2016;29:408-412.
-
Arens R, McDonough JM, Costarino AT, et al. Magnetic resonance ımaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001;164(4):698-703.
-
Wang J, Zhao Y, Yang W, et al. Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children of different weight status. Sci Reports. 2019;9:1-7.
-
Zhu Y, Wang S, Yang Y, et al. Adenoid lymphocyte heterogeneity in pediatric adenoid hypertrophy and obstructive sleep apnea. Front Immunol. 2023;14:1186258.
-
Major MP, El-Hakim H, Witmans M, Major PW, Flores-Mir C. Adenoid hypertrophy in pediatric sleep disordered breathing and craniofacial growth: the emerging role of dentistry. J Dent Sleep Med. 2014;1(2):83-87.
-
Dragendorf E, Bültmann E, Wolff D. Quantitative assessment of neurodevelopmental maturation: a comprehensive systematic literature review of artificial intelligence-based brain age prediction in pediatric populations. Front Neuroinformatics. 2024;18:1496143.
-
Griffiths-King D, Wood AG, Novak J. Predicting ‘Brainage’ in late childhood to adolescence (6-17yrs) using structural MRI, morphometric similarity, and machine learning. Sci Reports. 2023;13:1-14.
-
Liang H, Zhang F, Niu X. Investigating systematic bias in brain age estimation with application to post‐traumatic stress disorders. Hum Brain Mapp. 2019;40(11):3143-3152.
-
Zhang B, Zhang S, Feng J, Zhang S. Age-level bias correction in brain age prediction. Neuroimage Clin. 2023;37:103319.
-
Lu C, Li B, Zhang Q, et al. An individual-level weighted artificial neural network method to improve the systematic bias in BrainAGE analysis. Cereb Cortex. 2023;33(10):6132-6138.
-
Kurth F, Levitt JG, Gaser C, et al. Preliminary evidence for a lower brain age in children with attention-deficit/hyperactivity disorder. Front Psychiatry. 2022;13:1019546.
-
Huang X, Tang S, Lyu X, Yang C, Chen X. Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis. Sleep Med. 2019;54:195-204.
-
Shi Y, Chen L, Chen T, et al. A meta-analysis of voxel-based brain morphometry studies in obstructive sleep apnea. Sci Reports. 2017;7(1):10095.
-
Mathew N, Isaiah A. Brain magnetic resonance ımaging findings in children with obstructive sleep apnoea: a review. US Respir Pulm Dis. 2022;7:21-24.
-
Aycan N, Arslan H. Is adenoid hypertrophy associated with childhood afebrile seizure? Bagcilar Med Bull. 2024;9(3):162-166.
ADENOİD HİPERTROFİSİ OLAN PEDİATRİK BİREYLERDE BEYİN ANATOMİK YAPILARINDA GELİŞİMSEL FARKLILIKLAR VAR MI? RETROSPEKTİF BİR MANYETİK REZONANS GÖRÜNTÜLEME ÇALIŞMASI
Yıl 2025,
Cilt: 6 Sayı: 3
,
118
-
124
,
30.12.2025
Sefa Işıklar
,
Dilek Sağlam
Öz
Amaç: Adenoid hipertrofisi (AH), uykuda solunum bozukluğu ve obstrüktif uyku apnesine neden olarak beyinde değişikliklere neden olabilir. Ancak, AH'nin bu hastalıklardan bağımsız olarak beyin anatomisini tek başına etkileyip etkilemediği araştırılmamıştır. Bu çalışmada AH'nin beyin gelişimi üzerindeki etkilerini tahmini beyin yaşı (TBY) yöntemi ile inceledik.
Yöntem: Bu retrospektif çalışmaya 1-12 yaşları arasında AH'li 55 birey (39 erkek) ve benzer yaş ve cinsiyette AH'siz 55 birey katıldı. AH'yi saptamak için adenoid-nazofaringeal orandan (ANO: adenoid kalınlığının nazofarenks genişliğine oranı) yararlandık. Beyin anatomik yapıları üzerinde TBY için volBrain'in BrainStructureAges (BSA) veri hattını kullandık. Veriler SPSS (versiyon 28) ile karşılaştırıldı.
Bulgular: ANO değerlerinin AH grubunda (0.66±0.06) kontrol grubuna (0.40±0.09) göre anlamlı derecede daha yüksek olduğunu gözlemledik (p<0.05). Ortalama ANO değeri 0.60-0.69 arasında olduğundan AH grubu hafif derecede obstrüksiyona sahipti. Bu çalışmada AH ve kontrol gruplarındaki çocukların ortalama kronolojik yaşı 5.07±2.80 yıl idi. AH grubu (6.85±3.18 yıl) ile kontrol grubu (6.97±3.30 yıl) arasında global beyin ortalama TBY'si açısından anlamlı bir fark tespit edilmedi (p>0.05). Kortikal ve subkortikal anatomik bölgelerin ortalama EBA değerleri AH grubunda 6.51 yıl ile 7.97 yıl arasında, kontrol grubunda ise 6.56 yıl ile 8.22 yıl arasındaydı. Beyin bölgelerinin EBA değerleri açısından AH ve kontrol gruplarının arasında istatistiksel olarak anlamlı bir fark yoktu (p>0.05).
Sonuç: Bu çalışma, hafif AH'nin TBY açısından çocukların beyin gelişimini olumsuz etkilemediğini gösterdi. Seçilen kortikal ve subkortikal bölgelerde TBY’de küçük sapmalar gözlemlenmiş olsa da bu varyasyonlar normal gelişimsel heterojenlik aralığında kaldı. Bu bulgular, hafif AH'nin pediatrik popülasyonda beyin gelişimi için bağımsız bir risk faktörü olmadığını gösterdi.
Kaynakça
-
van Cauwenberge PB, Bellussi L, Richard Maw A, Paradise JL, Solow B. The adenoid as a key factor in upper airway infections. Int J Pediatr Otorhinolaryngol.1995;32:S71-S80.
-
Boyaka PN, Wright PF, Marinaro M, et al. Human nasopharyngeal-associated lymphoreticular tissues: functional analysis of subepithelial and ıntraepithelial b and t cells from adenoids and tonsils. Am J Pathol. 2000;157:2023-2035.
-
Meyer W, Marshall J. On adenoid vegetations in the naso-pharyngeal cavity: their pathology, diagnosis, and treatment. Med Chir Trans. 1870;53:191-216.
-
Hu Z, Dong J, Lou M, et al. Effect of different degrees of adenoid hypertrophy on pediatric upper airway aerodynamics: a computational fluid dynamics study. Biomech Model Mechanobiol. 2023;22:1163-1175.
-
Greenfeld M, Tauman R, DeRowe A, Sivan Y. Obstructive sleep apnea syndrome due to adenotonsillar hypertrophy in infants. Int J Pediatr Otorhinolaryngol. 2003;67:1055-1060.
-
Chi L, Comyn FL, Mitra N, et al. Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI. Eur Respir J. 2011;38:348-358.
-
Philby MF, Macey PM, Ma RA, Kumar R, Gozal D, Kheirandish-Gozal L. Reduced regional grey matter volumes in pediatric obstructive sleep apnea. Sci Rep. 2017;7:44566.
-
Eun YJ, Woo ST, Sun JH, Cho JW, Seung BH. Reduced cerebral blood flow during wakefulness ın obstructive sleep apnea-hypopnea syndrome. Sleep. 2007;30:1515-1520.
-
Bålfors EM, Franklin KA. Impairment of cerebral perfusion during obstructive sleep apneas. Am J Respir Crit Care Med. 1994;150:1587-1591.
-
Tan HL, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: A critical update. Nat Sci Sleep. 2013;5:109-123.
-
Rosenzweig I, Glasser M, Polsek D, Leschziner GD, Williams SCR, Morrell MJ. Sleep apnoea and the brain: a complex relationship. Lancet Respir Med. 2015;3:404-414.
-
Thabit MN, Elnady HM, Badawy BS, Mahmoud HA. Cognitive event-related potentials in patients with adenoid hypertrophy: A case-control pilot study. J Clin Neurophysiol. 2016;33:443-449.
-
Kurnatowski P, Putyński L, Łapienis M, Kowalska B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2006;70:419-424.
-
Ma Y, Niu Z, Ruan L, et al. Alterations in amygdala/hippocampal volume ratios in children with obstructive sleep apnea syndrome caused by adenotonsillar hypertrophy. Med Sci Monit. 2023;29:e937420.
-
Kheirandish-Gozal L, Sahib AK, Macey PM, Philby MF, Gozal D, Kumar R. Regional brain tissue integrity in pediatric obstructive sleep apnea. Neurosci Lett. 2018;682:118-123.
-
Brooks LJ, Stephens BM, Bacevice AM. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr. 1998;132:682-686.
-
Nguyen HD, Clément M, Mansencal B, Coupé P. Brain structure ages-a new biomarker for multi-disease classification. Hum Brain Mapp. 2024;45:e26558.
-
Capitanio MA, Kirkpatrick JA. Nasopharyngeal lymphoid tissue. Roentgen observations in 257 children two years of age or less. Radiology.1970;96:389-391.
-
Fedorov A, Beichel R, Kalpathy-Cramer J, et al. 3D Slicer as an image computing platform for the quantitative ımaging network. Magn Reson Imaging. 2012;30:1323-1341.
-
Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. Am J Roentgenol. 1979;133:401-404.
-
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods. 2007;39(2):175-191.
-
Cohen J. Statistical power analysis for the behavioral sciences. Stat Power Anal Behav Sci. 2013.
-
Surov A, Ryl I, Bartel-Friedrich S, Wienke A, Kösling S. MRI of nasopharyngeal adenoid hypertrophy. Neuroradiol J. 2016;29:408-412.
-
Arens R, McDonough JM, Costarino AT, et al. Magnetic resonance ımaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001;164(4):698-703.
-
Wang J, Zhao Y, Yang W, et al. Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children of different weight status. Sci Reports. 2019;9:1-7.
-
Zhu Y, Wang S, Yang Y, et al. Adenoid lymphocyte heterogeneity in pediatric adenoid hypertrophy and obstructive sleep apnea. Front Immunol. 2023;14:1186258.
-
Major MP, El-Hakim H, Witmans M, Major PW, Flores-Mir C. Adenoid hypertrophy in pediatric sleep disordered breathing and craniofacial growth: the emerging role of dentistry. J Dent Sleep Med. 2014;1(2):83-87.
-
Dragendorf E, Bültmann E, Wolff D. Quantitative assessment of neurodevelopmental maturation: a comprehensive systematic literature review of artificial intelligence-based brain age prediction in pediatric populations. Front Neuroinformatics. 2024;18:1496143.
-
Griffiths-King D, Wood AG, Novak J. Predicting ‘Brainage’ in late childhood to adolescence (6-17yrs) using structural MRI, morphometric similarity, and machine learning. Sci Reports. 2023;13:1-14.
-
Liang H, Zhang F, Niu X. Investigating systematic bias in brain age estimation with application to post‐traumatic stress disorders. Hum Brain Mapp. 2019;40(11):3143-3152.
-
Zhang B, Zhang S, Feng J, Zhang S. Age-level bias correction in brain age prediction. Neuroimage Clin. 2023;37:103319.
-
Lu C, Li B, Zhang Q, et al. An individual-level weighted artificial neural network method to improve the systematic bias in BrainAGE analysis. Cereb Cortex. 2023;33(10):6132-6138.
-
Kurth F, Levitt JG, Gaser C, et al. Preliminary evidence for a lower brain age in children with attention-deficit/hyperactivity disorder. Front Psychiatry. 2022;13:1019546.
-
Huang X, Tang S, Lyu X, Yang C, Chen X. Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis. Sleep Med. 2019;54:195-204.
-
Shi Y, Chen L, Chen T, et al. A meta-analysis of voxel-based brain morphometry studies in obstructive sleep apnea. Sci Reports. 2017;7(1):10095.
-
Mathew N, Isaiah A. Brain magnetic resonance ımaging findings in children with obstructive sleep apnoea: a review. US Respir Pulm Dis. 2022;7:21-24.
-
Aycan N, Arslan H. Is adenoid hypertrophy associated with childhood afebrile seizure? Bagcilar Med Bull. 2024;9(3):162-166.