三叉神经痛病人三叉神经和脑白质改变的DTI研究

Change of trigeminal nerve and brain white matter on diffusion tensor imaging in patients with trigeminal neuralgia

目的探讨三叉神经痛(TN)病人的三叉神经脱髓鞘与脑白质结构改变的关系。方法收集30例原发性TN病人和30例健康志愿者,均接受常规头颅MRI扫描、三叉神经及全脑扩散张量成像(DTI)数据采集。采用单因素方差分析比较TN病人患侧、健侧和正常对照组之间的三叉神经DTI参数[各向异性分数(FA)、平均扩散系数(MD)、轴向扩散系数(AD)和径向扩散系数(RD)];运用基于纤维束示踪的空间统计分析(TBSS)方法对TN病人和正常对照组之间的全脑白质DTI指标进行体素水平比较,并经过多重比较校正,获取有统计学意义的组间差异脑区。对TN病人的三叉神经DTI指标与差异脑区DTI指标进行Pearson相关分析。结果TN病人患侧三叉神经FA值低于健侧及正常对照组,MD值、AD值和RD值高于健侧及正常对照组(均P<0.05)。TN组健侧前放射冠FA值呈显著减低(P<0.05,TFCE及FWE校正),且其FA值与患侧三叉神经FA值呈正相关(r=0.581,P<0.05),与患侧三叉神经RD值呈负相关(r=-0.389,P<0.05)。结论TN导致病人的三叉神经和脑白质结构的完整性受损,而且脑白质损伤程度与三叉神经脱髓鞘程度具有显著相关性。

Objective To explore the relationship between demyelination of trigeminal nerve and brain white matter change in patients with trigeminal neuralgia(TN).Methods Thirty patients with primary TN and thirty healthy subjects were collected and underwent conventional brain MRI scan and diffusion tensor imaging(DTI)of trigeminal nerve and whole brain.One way ANOVA was used to compare the DTI metrics[fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),and radial diffusivity(RD)]of trigeminal nerve between the ipsilateral side,the contralateral side,and healthly controls.Voxel-wise analyses were performed with tract-based spatial statistics(TBSS)using DTI metrics between TN patients and healthy controls.Multiple comparisons and correction were used and brain regions with significantly intergroup difference were obtained.Pearson correlation analyses were performed between DTI metrics of the brain regions and trigeminal nerve in patients with TN.Results The FA value of ipsilateral trigeminal nerve in TN patients was significantly lower than that of contralateral trigeminal nerve and control group(all P<0.05).The MD value,AD value and RD value of ipsilateral trigeminal nerve in TN patients were significantly higher than those of the contralateral trigeminal nerve and control group(all P<0.05).The TN group showed significantly reduced FA in contralateral anterior corona radiata(P<0.05,TFCE and FWE correction).Moreover,the FA value of contralateral anterior corona radiata was positively correlated with the FA value of ipsilateral trigeminal nerve(r=0.581,P<0.05)and negatively correlated with the RD value of ipsilateral trigeminal nerve(r=-0.389,P<0.05).Conclusion TN results in damage of trigeminal nerve and brain white matter integrity,and there is significant correlation between white matter damage and demyelination of trigeminal nerve.