膝骨性关节炎患者脑结构和功能变化的多模态MRI

Multimodal magnetic resonance imaging study of brain structure and function changes in patients with knee osteoarthritis

目的联合基于体素的形态学测量(VBM)技术和静息态功能磁共振成像(rs-fMRI)技术探究膝骨性关节炎(KOA)患者静息状态下脑灰质体积、脑神经元活动强度及基于种子点的功能连接强度改变,综合分析KOA相关异常脑网络。方法前瞻性收集30例KOA患者(KOA组)及30例健康人(HC组)的3D高分辨率T1WI像和rs-fMRI图像,采用VBM、低频振幅、功能连接3种方法分析两组间脑灰质结构和功能数据差异。结果与HC组相比,KOA组双侧梭状回、右侧颞中回低频振幅值增高,右侧楔前叶、右侧内侧前额叶皮质、左侧额中回低频振幅值减低(体素水平P<0.005,团块水平P<0.05);右侧楔前叶、右侧顶下小叶、右侧初级视觉皮层、左侧颞中回、左侧中央后回灰质体积减小(体素水平P<0.002,团块水平P<0.05);以右侧楔前叶为种子点,与右侧颞中回的功能连接增强,与左侧前扣带回、左侧背外侧前额叶皮质的功能连接降低(体素水平P<0.005,团块水平P<0.05)。结论KOA患者感知皮层系统及联合皮层系统阵营均存在血氧水平依赖信号及灰质微结构的改变且有重叠,主要涉及视觉网络、感觉运动网络、默认状态网络、执行控制网络内及默认状态网络、执行控制网络、突显网络的部分脑区间,这可能提示KOA患者不仅处于慢性疼痛的病理状态,还伴有信息整合、注意力控制、情绪反应、情感解读等功能活动的异常。

Objective To explore the change of brain gray matter volume,neuron activity and functional connectivity strength based on seed points in patients with knee osteoarthritis(KOA)at rest through combined voxel based morphology and rsfMRI technology,and comprehensively analyze KOA-related abnormal brain networks.Methods 3D high-resolution T1WI images and rs-fMRI images of 30 patients with KOA(KOA group)and 30 healthy controls(HC group)were collected prospectively.Voxel based morphology,amplitude of low-frequency fluctuation,and functional connectivity were used to analyze the differences in gray matter structural and functional data between the two groups.Results Compared with the HC group,the amplitude of low-frequency fluctuation values of bilateral fusiform gyrus and right middle temporal gyrus in KOA group increased,while the amplitude of low-frequency fluctuation values of right precuneus,right medial prefrontal cortex and left middle frontal gyrus decreased(voxel level P<0.005,cluster level P<0.05).The gray matter volume of right precuneus,right inferior parietal lobule,right primary visual cortex,left middle temporal gyrus,left postcentral gyrus decreased(voxel level P<0.002,cluster level P<0.05).With the right precuneus as the seed point,the functional connectivity with right middle temporal gyrus was enhanced,and the functional connectivity with left anterior cingulate gyrus,left dorsolateral prefrontal cortex was reduced(voxel level P<0.005,cluster level P<0.05).Conclusion The changes of BOLD signal and gray matter microstructure were found in both perceptual cortex system and combined cortex system of KOA patients,There are overlap,mainly involving in the visual network,sensorimotor network,default mode network,executive control network within and between partial brain regions of default mode network,executive control network and salience network.This may suggest that KOA patients are not only in the pathological state of chronic pain,but also accompanied by abnormalities in functional activities such as information integration,attentional control,emotional response,and emotional interpretation.