脊髓型颈椎病患者大脑功能改变的初步磁共振研究

A Preliminary MRI Study of Brain Function Changes in Patients with Cervical Spondylotic Myelopathy

目的研究不同严重度的脊髓型颈椎病(CSM)患者大脑神经元自发性活动强度的变化,从大脑静息态功能角度理解CSM患者的功能损害。方法基于日本骨科协会(JOA)17分法分组,对22例轻中度、18例重度CSM患者及25例年龄、性别等均匹配健康对照组(HC)行静息态功能磁共振成像(rs-fMRI)和临床功能评估(JOA、NDI),应用低频振幅(ALFF)分析方法比较三组间大脑功能活动强度差异,与功能量表行相关分析。结果与HC组比较,两组CSM患者的左内侧额上回的ALFF值减低,重度CSM组右侧颞中回的ALFF值显著高于轻、中度CSM组和HC组。除左内侧额上回和右侧颞中回外,与HC组相比,重度CSM组左侧眶部额中回、尾状核ALFF降低,轻、中度CSM组左侧中央旁小叶的ALFF显著增高(体素P值<0.001,簇P值<0.05,GRF校正)。CSM患者右侧颞中回ALFF值与JOA评分呈负相关(r=-0.319,P<0.05)。结论 CSM患者存在多个脑区自发神经活动异常,右侧颞中回升高的ALFF值可能是反映CSM病情进展的定量影像指标。

Objective The aim of this study was to investigate the functional impairment of cervical spondylotic myelopathy(CSM) from the perspective of amplitude of low-frequency fluctuation(ALFF) and its relationship with their clinical manifestations. Methods We recruited 40 patients with CSM(22 mild-moderate CSM,18 severe CSM),and 25 healthy controls(HCs) matched for age, sex and education status. The ALFF method was used to evaluate the altered spontaneous brain activities. The relationships between the mean ALFF signal values of different brain regions and the clinical features were evaluated by correlation analysis. Results Compared with HCs, the two CSM groups showed decreased ALFF in the left superior frontal gyrus(SFGmed). More importantly, the severe group exhibited significantly increased ALFF in the right middle temporal gyrus(MTG)(P<0.05). In addition to the left SFGmed and right MTG,the severe group, compared with HCs, also showed lower ALFF in the left middle frontal area(ORBmid) and caudate nucleus(CAU). Compared with HCs, mild-moderate group had significantly higher ALFF in the left paracentral lobule(PCL). The ALFF value of the right mid-temporal gyrus was negatively correlated with the JOA score(r =-0.319,P<0.05). Conclusion Our results suggest that increased ALFF in the right MTG may be a pathological feature exclusive to evaluate the condition of CSM.