三叉神经痛患者半月节射频热凝术前后静息态fMRI的变化

Changes of resting-state fMRI in trigeminal neuralgia after percutaneous radiofrequency thermocoagulation

目的利用功能MR研究三叉神经痛患者半月节射频热凝术(PRT)前后脑功能局部一致性(ReHo)变化。方法对31例接受PRT手术的三叉神经痛患者在术前1周及术后6个月分别进行MR扫描,采集其大脑结构及静息态功能图像;同时记录患者的疼痛视觉模拟量表(VAS)评分、面部麻木程度及患病时间。比较患者手术前后全脑ReHo值出现显著变化的脑区,再将这些脑区的平均ReHo值与临床观察指标进行相关分析。结果与术前相比,患者术后右侧梭状回(FG)和双侧前扣带回(ACC)的ReHo值显著增高(P均<0.05),而左侧顶下小叶(IPL)、右侧距状回、右侧颞中回(MTG)、左侧中央后回(PoCG)以及左侧岛叶的ReHo值显著降低(P均<0.05)。左侧PoCG的ReHo值与手术前后VAS评分呈正相关,术前右侧MTG的ReHo值与手术前后VAS的变化值呈负相关。结论 PRT术后多个脑区的Re-Ho出现显著变化,这些区域与痛觉感知、情感表达及情绪体验密切相关,其中左侧PoCG具有作为靶点判断疼痛部位及评估疼痛强度的潜在价值。

Objective To investigate regional homogeneity （ReHo） changes in patients with trigeminal neuralgia （TN） before and after percutaneous radiofrequency thermocoagulation （PRT） procedure by resting-state fMRI. Methods Totally 31 TN patients underwent PRT procedure underwent MR scans 1 week before and 6 months after surgery. The anatomical and resting-state functional images were acquired. Voxel-wise ReHo analysis was performed to detect the altered regional clusters after surgery. The correlations between the mean ReHo values of each significant cluster and clinical variables such as visual analogue scale （VAS） scores, degree of facial numbness and time of illness were analyzed. Results Compared with pre-surgical condition, patients after PRT procedure showed that the significant ReHo value increased in the right fusiform gyrus （FG） and bilateral anterior cingulate cortex （ACC, both P〈0.05）, but decreased in the left inferior parietal lobule （IPL）, right calcarine, right middle temporal gyrus （MTG）, left postcentral gyrus （PoCG） and left insula （all P〈 0.05）. There were positive correlation between ReHo in the left PoCG and VAS scores, and there were negative correla tion between pre-surgical ReHo in the right MTG and VAS changes. Conclusion Alterations of ReHo post-surgical are found in several regions, which are related to sensory, affective and emotional processes. The left PoCG may play an important role in defining pain regions and monitoring pain intensities.