慢性偏头痛患者脑白质弥散张量成像ABA及TBSS分析

Diffusion tensor imaging in patients with chronic migraine:an analysis with atlas-based analysis and tract-based spatial statistics

目的采用弥散张量成像(DTI)技术研究慢性偏头痛(CM)患者脑白质结构损伤及其与临床资料的相关性。方法选取成都中医药大学附属医院神经内科、神经外科门诊自2020年9月至2022年12月收治的CM患者60例(CM组),自2020年10月至2022年6月向社会招募与CM患者年龄、性别相匹配的健康对照者60例(健康对照组)。2组受试者均进行全脑DTI扫描,使用PANDA及FSL软件进行DTI数据全自动处理,采用基于白质图谱的分析(ABA)及纤维束示踪空间统计(TBSS)分析CM患者及健康对照者全脑DTI数据的差异,采用Pearson相关性检验分析CM患者临床特征与ABA结果的相关性。结果ABA结果显示:与健康对照组比较,CM组患者双侧大脑脚、左侧小脑下脚、右侧小脑上脚、双侧内侧丘系、双侧毯(胼胝体内矢状层)、双侧钩束及右侧内囊后肢脑区的各向异性分数(FA)值降低,右侧扣带回、内囊豆状核后部脑区的平均弥散率(MD)值增高,双侧大脑脚、双侧内侧丘系、右侧扣带回脑区轴向弥散率(AD)值降低,左侧毯(胼胝体内矢状层)、左侧小脑下脚、左侧大脑脚脑区径向弥散率(RD)值增高,差异均有统计学意义(P<0.05)。TBSS结果显示:CM组及健康对照组脑白质纤维骨架FA、MD、RD及AD值差异均无统计学意义(P<0.05)。CM患者头痛视觉模拟评分(VAS)与左侧小脑下脚、左侧内侧丘系、右侧大脑脚FA值,右侧大脑脚的AD值,左侧毯(胼胝体内矢状层)RD值呈负相关关系(P<0.05);CM患者病程与左侧小脑下脚FA值呈负相关关系,与左侧小脑下脚的RD值呈正相关关系(P<0.05)。结论CM患者脑白质存在结构损伤,但白质纤维骨架与正常人无差异,无纤维骨架的病理性损害。脑干、小脑及胼胝体结构变化与头痛VAS评分及病程有相关性,可能是CM发病的重要因素。

Objective To study the structural damage of cerebral white matter in patients with chronic migraine(CM)using magnetic resonance diffusion tensor imaging(DTI),and analyze its correlation with clinical data.Methods Sixty CM patients,enrolled from Outpatient of Departments of Neurosurgery and Neurology,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from September 2020 to December 2022,were chosen;and from October 2020 to June 2022,60 healthy controls matched with age and gender were recruited socially.All subjects accepted whole brain DTI.DTI data were automatically processed by PANDA and FSL softwares,differences of whole brain DTI data between CM patients and healthy controls were compared by atlas-based analysis(ABA)and tract-based spatial statistics(TBSS),and correlations of clinical features with ABA results were analyzed by Pearson correlation in CM patients.Results In ABA,compared with the healthy control group,the CM group had significantly decreased FA values in the bilateral cerebral peduncles,left inferior cerebellar peduncles,right superior cerebellar peduncles,bilateral medial thalamic tracts,bilateral tapetum(the inner sagittal layer of the corpus callosum),bilateral hook bundles,and right posterior limb of the internal capsule(P<0.05);compared with the healthy control group,the CM group had significantly increased mean diffusivity(MD)in the right cingulate gyrus and posterior part of the internal lenticular nucleus,statistically decreased axial diffusivity(AD)in the bilateral cerebral peduncles,bilateral medial thalamic tracts,and right cingulate gyrus(P<0.05);compared with the healthy control group,the CM group had significantly increased radial diffusivity(RD)in the left tapetum,left inferior cerebellar peduncles,and cerebral peduncles(P<0.05).In TBSS,no differences in FA,MD,RD and AD in the white matter fiber skeleton were noted between the 2 groups(P>0.05).In CM patients,visual analogue scale(VAS)scores were negatively correlated with FA in the left subiculum,left medial colliculus and right cerebral peduncle,AD in the right cerebral peduncle,and RD in the left tapetum(P<0.05);disease duration was negatively correlated with FA in the left subiculum peduncle and positively correlated with RD in the left subiculum peduncle(P<0.05).Conclusions Notwithstanding the structural damage of cerebral white matter in CM patients,the white matter fiber skeleton remains unaltered from normal subjects,without pathological damage of the fiber skeleton.Structural changes in the brainstem,cerebellum and corpus callosum are associated with VAS scores and disease duration,and may be important factors for CM pathogenesis.