纤维示踪成像技术对多发性硬化引起的三叉神经痛病人的影像学研究

TRACTOGRAPHY STUDY OF THE TRIGEMINAL NERVE IN PATIENTS WITH TRIGEMINAL NEURALGIA DUE TO MULTIPLE SCLEROSIS

目的:三叉神经痛(trigeminal neuralgia,TN)是多发性硬化症状之一。应用扩散张量成像纤维示踪(Diffusion tensor imaging fiber tracer technology,DTI-FT)技术研究多发性硬化(multiple sclerosis,MS)无神经血管原因、无可视三叉神经病灶,但有TN症状病人的神经纤维微观结构改变,并探讨其临床应用价值。方法:收集MS三叉神经痛病人20例及健康对照组20例,两组年龄、性别相符,利用纤维示踪技术追踪所有被试两侧三叉神经纤维走行,比较MS三叉神经痛组和健康对照组的双侧纤维追踪图及纤维束的部分各向异性(Fractional anisotropy,FA)和表观弥散系数(Apparent diffusion coefficient,ADC),并将MS组感兴趣区FA、ADC分别与临床扩展残疾状态量表(expanded disability states scale,EDSS)评分、病程行Pearson相关分析。结果:MS组患TN侧与健侧与健康对照组病人相比、患TN侧与健侧相比,FA值降低,差别均具有统计学意义(P<0.05);MS组患侧与健康对照组相比、健侧与健康对照组相比,ADC值差别均具有统计学意义(P<0.05),但患TN侧与健侧相比,ADC值差别无统计学意义。FA值和临床EDSS评分、病程具有负相关性(P<0.05),ADC与临床数据无相关性。结论:MS病人不仅患TN侧三叉神经DTI参数存在异常,健侧亦存在异常,DTI可发现常规磁共振检测不到的微观损伤,为临床MS三叉神经功能损伤提供直接证据、揭示病理改变。

Objective： Trigeminal neuralgia is one of the symptoms of multiple sclerosis （MS）. In this study, we used diffusion tensor imaging fiber tracer （DTI-FT） technology to investigate fiber microstructure change of MS patients who have trigeminal neuralgia symptoms but without nerve vascular changes or apparent trigeminal nerve lesions, and explored its clinical application value. Methods： 20 MS patients with trigeminal neuroglia and 20 age- and gender-matched and 20 healthy control group were recruited. DTI data were compared between these two groups. The relationships between the expanded disability states scale （EDSS） scores and DTI parameters of the interesting regions were further explored. Results： Comparing the controls and non-affected side with the TN affected side or comparing the affected side with the contralateral side, FA value was lower and the differences were statistically significant （P 〈 0.05）; Comparing the affected side and non-affected side of healthy controls, the difference of ADC was significantly decreased （P 〈 0.05）, but when comparing TN affected side with the contralateral side, no difference of ADC values was found. FA values and clinical EDSS scores have a negative correlation （P 〈 0.05）, but the ADC has no significant correlation with clinical data. Conclusion： Trigeminal DTI parameters were abnormal for MS patients not only in the TN affected side but also in the contralateral side. DTI can find the microscopic damage that conventional MRI can not detect. At the same time, DTI can provide direct evidence for clinical function of MS trigeminal nerve injury and reveal the pathological changes.