基于体素的形态学测量-自建模板及微分同胚图像融合算法评价近期发病创伤后应激障碍患者脑结构

Voxel-based morphometry-diffeomorphic anatomical registration through exponentiated lie algebra algorithm evaluation of brain structural of recent-onset post-traumatic stress disorder patients

目的采用基于体素形态学测量-自建模板及微分同胚图像融合（VBM-DARTEL）算法,对比近期发病创伤后应激障碍（PTSD）患者与有创伤暴露史的健康对照（TEHC）间脑结构的体积差异,分析差异脑区的体积与患者症状严重程度的相关性。方法采集地震后7-15个月右利手的地震幸存者的高分辨率三维T1WI图像,其中近期发病PTSD患者28例（PTSD组）、TEHC 28名（TEHC组）。采用MatLab 2012b工作平台下SPM8软件的VBM-DARTEL工具包预处理图像。以性别、年龄、受教育程度、地震后时间及颅内容积为协变量,对比两组间全脑灰质和白质的体积差异。以与上述相同的协变量评价差异脑区的体积与患者临床创伤后应激障碍诊断量表（CAPS）评分间的相关性。结果与TEHC组相比,PTSD组右侧舌回灰质体积增加,右侧楔叶、右侧枕中回、右侧丘脑及双侧颞上回灰质体积缩小,左侧颞上回白质体积缩小。两组间海马灰质体积差异无统计学意义。左侧颞上回灰质体积与患者CAPS评分呈负相关。结论近期发病PTSD患者结构改变以部分脑区灰白质萎缩为主。近期发病PTSD患者海马体积无萎缩可能是与病程延续数年PTSD患者不同的脑结构特征。

Objective To compare brain structural difference between recent-onset post-traumatic stress disorder （PTSD） patients and trauma-exposed healthy controls （TEHC） using voxel-based morphometry （VBM）-diffeomorphic anatomical registration through exponentiated lie algebra （DARTEL） algorithm, and evaluate the relationship between volume of altered brain and symptom severity. Methods High-resolution 3-dimensional T1WI images were obtained from right-handed earthquake survivors, including 28 drug-naive first-episode recent-onset PTSD patients （PTSD group） and 28 TEHC （TE- HC group） within 7 to 15 months after the earthquake. All images were preprocessed with VBM-DARTEL algorithm of SPM8 software running in MatLab 2012b. Gray matter and white matter volume differences between both groups were analyzed with age, sex, years of education, duration from the earthquake and intracranial volume as covariates. The relation- ships between volumes of altered structures and clinician-administered PTSD scale （CAPS） scores in patients were evaluated with the same covariates mentioned above. Results Compared with TEHC group, gray matter volume in the right lingual gyrus increased, and gray matter volume in the right cuneus gyrus, the right middle occipital gyrus, the pulvinar of the right thalamus and both sides superior temporal gyrus reduced and white matter volume in the right middle temporal gyrus decreased in PTSD group. There were no significant difference of gray matter volume in the hippocampus between both groups. Gray matter volume of the left superior temporal gyrus was negatively correlated with CAPS scores in PTSD group. Conclusion The characteristics of brain in recent-onset PTSD patients are mainly atrophy in some regions of gray matter and white matter. Compared with TEHC, recent-onset PTSD patients without hippocampal atrophy may be the unique structural feature which relates to advanced/chronic PTSD patients.