原发性三叉神经痛灰质体积变化的磁共振形态学研究

Altered gray matter volume in primary trigeminal neuralgia: a voxel based morphometry MRI study

目的应用基于体素的形态学分析方法检测原发性三叉神经痛患者是否存在灰质体积改变,探索中枢神经系统在其疼痛处理中的作用。材料与方法对19例右侧三叉神经痛患者和22例年龄性别匹配的正常对照进行磁共振三维T1结构像扫描(3D-T1BRAVO),应用基于体素形态学分析(voxel-based morphometry,VBM)检测三叉神经痛患者全脑灰质体积的变化,探索各变化的中枢神经系统脑区在疼痛处理中的作用,并分别分析其体积变化与疼痛程度及病程的相关性。结果与正常对照组相比,病例组左侧前扣带回灰质体积明显减少;右侧额上回、右侧岛叶、右侧壳核、双侧小脑前叶灰质体积明显增加,左侧前扣带回体积变化与疼痛病程呈负相关性。结论三叉神经痛患者存在中枢神经系统灰质体积变化,左侧前扣带回体积与疼痛病程呈负相关性,这些存在差异的中枢神经系统脑区在三叉神经痛患者疼痛的形成及慢性状态的维持中可能有重要作用,提示探索三叉神经痛的中枢处理机制有益于新的治疗方法的研发。

Objective： To detect whether there is gray matter volume（GMV） alteration and further analyze the involvement of central nervous system in pain processing in trigeminal neuralgia patients. Materials and Methods： Nineteen patients diagnosed with trigeminal neuralgia and twenty-two age-matched, sex-matched normal volunteers as controls were recruited. T1-weighted 3D BRAVO sagittal images were obtained from all subjects. Voxel based morphometry（VBM） was used to identify GMV differences between patients and normal controls. The correlation between altered GMVs and disease duration as well as altered GMVs and pain intensity were also analyzed in trigeminal neuralgia patients. Results： Compared with normal controls, patients with trigeminal neuralgia had decreased GMV in left anterior cingulate as well as increased GMVs in right superior frontal gyrus, right insula, right putamen and bilateral cerebellum. Otherwise, we found a negative correlation between pain duration and altered GMV of the left anterior cingulate which is an important region for the development and maintenance of pain in trigeminal neuralgia. Conclusion： The altered GMV in central nervous system and the negative correlation between disease duration and altered GMV of the anterior cingulate may suggest that these central brain regions are extremely important for the development and maintenance of pain in trigeminal neuralgia, which reveals that exploring the central mechanisms of pain processing in trigeminal neuralgia may benefi t new therapeutic methods in the future.