偏头痛血管周围间隙的磁共振特征分析

Magnetic resonance imaging characteristics of perivascular space in migraine

目的利用磁共振成像技术，分析偏头痛患者血管周围间隙（Virchow-Robinspaces，VRS）分布特征，研究偏头痛患者病程、发作频率及有无先兆对VRS数目的影响，以期为偏头痛诊断提供影像学支持。方法收集2013年1月至2016年12月于本院神经内科病房住院的50例偏头痛患者作为偏头痛组，并以同期50名健康体检者作为对照组。对所有入组者进行相同序列的头颅MRI检查，计算额顶叶皮质下白质区、半卵圆中心区、基底节区的VRS数目并对其进行组问和组内比较，进一步对偏头痛患者的病程、发作频率及有无先兆对VRS数目的影响进行分析。结果偏头痛组VRS检出者有48例（96％），明显高于对照组的41例（82％），差异具有统计学意义（X^2=5．00，P〈0．05）。偏头痛组VRS总数目13．00（6．75，20．00）个，明显多于对照组8．00（5．00，12．00）个（Z=3．33，P〈0．01）。偏头痛组额顶叶皮质下白质区、半卵圆中心区、基底节区的VRS数目分别为6．00（4．00，12．00）、2．00（0．00，4．00）、4．00（2．00，6．00）个；对照组上述区域VRS数目分别为0．00（0．00，2．00）、2．00（0．75，4．00）、4．00（3．50，6．00）个，两组不同区域VRS数目经组内整体比较，差异均有统计学意义（偏头痛组X^2=39．86，P〈0．01；对照组∥=40．15，P〈0．01），偏头痛组中VRS主要分布在额顶叶皮质下白质区，对照组VRS主要分布在基底节区。有先兆偏头痛组的VRS总数目为20．00（14．50，26．00）个，多于无先兆偏头痛组的11．00（6．00，20．00）个（Z=2．52，P=0．02），且有先兆偏头痛组额顶叶皮质下白质区、半卵圆中心区、基底节区的VRS数目分别为12．00（9．00，14．00）、2．00（2．00，6．00）、4．00（2．50，7．50）个；无先兆偏头痛组上述区域VRS数目分别为6．00（4．00，10．00）、1．00（0．00，4．00）、4．00（2．00，6．00）个，两组不同区域VRS数目经组内整体比较差异均有统计学意义（有先兆偏头痛组X^2=16．31，P〈0．01；无先兆偏头痛组X^2=29．48，P〈0．01）。在无先兆偏头痛组，患者不同病程、发作频率对VRS数目的影响具有统计学意义。结论偏头痛患者VRS发生率较高，且主要分布在额顶叶皮质下白质区，可能为偏头痛的诊断提供影像学辅助依据；有先兆偏头痛者较无先兆偏头痛者更易好发VRS；疾病病程、发作频率对VRS的产生均有一定的影响。

Objective To analyze the distribution of Virchow-Robin spaces （VRS） in migraine by MRI, and to study the effects of the duration of the disease, the attack frequency and the migraine with or without aura on the number of VRS in order to provide imaging support for migraine diagnosis. Methods Fifty migraine patients were enrolled as migraine group and 50 healthy people as control group during January 2013 to December 2016 from Department of Neurology, the Second Affiliated Hospital of Zhengzhou University. The number of VRS in the fronto-parietal subcortieal white matter, semioval central, and basal ganglia areas was calculated and compared between groups and within the group by performing a MRI scan of the same sequence, and the impact of the history of migraine, the attack frequency and the migraine with or without aura on the number of VRS was investigated. Results The VRS were found in 48 cases in the migraine group, accounting for 96% , significantly higher than in the control group （41 cases, accounting for 82% ） , the difference being statistically significant （X^2 = 5. 00, P 〈 0. 05 ）. In the migraine group, the sum of the number of VRS （13.00（6. 75, 20. 00） ） was significantly higher than that of the control group （8.00 （5.00, 12.00）; Z= 3.33, P〈 0.01 ）. In the migraine group the VRS numbers in the fronto-parietal subcortical white matter, semioval central and basal ganglia areas were 6. 00 （4. 00, 12. 00） , 2. 00 （0. 00, 4. 00） and 4. 00 （2. 00, 6. 00） respectively, while the numbers of VRS in the same areas of the control group were 0. 00（0. 00, 2.00）, 2.00（0. 75, 4. 00） and 4. 00（3.50, 6. 00）. The total number of VRS in different areas was significantly different within the two groups （migraine group X^2 = 39.86, P 〈 0. 01; control group X^2=40. 15, P 〈0. 0l ）. In the migraine group, the VRS was mainly located in fronto-parietal subcortical white matter, whereas in the control group the VRS was mainly distributed in the basal ganglia. The total number of VRS in the migraine with aura group （20. 00 （ 14.50, 26.00） ） was more than that in the migraine without aura group （ 11.00 （6. 00, 20. 00） ; Z = 2.52, P = 0. 02）. The numbers of VRS in the fronto-parietal subcortical white matter, semioval central and basal ganglia areas of the migraine with aura group were 12.00（9. 00, 14. 00）, 2. 00（2.00, 6.00） and 4. 00（2. 50, 7.50） respectively; The numbers of VRS in the same areas of the migraine without aura group were 6. 00 （4. 00, 10. 00） , 1.00 （0. 00, 4. 00） and 4. 00 （ 2. 00, 6. 00 ） respectively ; The numbers of VRS in different areas within the two groups were significantly different （ with aura group X2 = 16. 31, P 〈 0. 01 ; without aura group X^2 = 29.48, P 〈 O. 01 ）. There were statistically significant differences in the number of VRS among migraine without aura patients with different duration and frequency of episodes. Conclusions The incidence rate of perivascular space in migraine is high. VRS is mainly distributed in the fronto-parietal subcortical white matter, which may provide an imaging assistant basis for the diagnosis of migraine. Migraine with aura is more prone to VRS than those without aura. The disease course and the attack freuuencv have a certain impact on occurrence of VRS.