乳腺癌化疗患者脑结构及功能磁共振成像研究

Brain structure and functional magnetic resonance imaging in patients with breast cancer undergoing chemotherapy

目的探讨乳腺癌化疗患者的脑灰质体积(gray matter volume,GMV)变化及静息状态下部分脑区与全脑功能连接(functional connectivity,FC)的改变。材料与方法本研究共纳入29名术后化疗前的乳腺癌患者(without chemotherapy treatment,C−)和30名化疗后乳腺癌患者(chemotherapy treatment,C+),分别进行了心理认知测试、结构及静息态功能MRI扫描,运用基于体素的形态学测量(voxel-based morphometry,VBM)方法对GMV进行分析,并选择体积变化脑区为感兴趣区(region of interest,ROI)进行全脑FC的分析。GMV比较及FC比较均采用双样本t检验分析方法。采用Spearman偏相关分析来探讨差异脑区GMV及FC值与心理认知测试结果之间的关系。结果与C−组相比,C+患者左侧枕中回(MNI:X,Y,Z=−10.5,−105.0,0.0)、右侧距状裂周围皮层(MNI:X,Y,Z=15.0,−103.5,−1.5)GMV减小(P<0.001,cluster size>90)。以左侧枕中回为种子点,与右侧颞极:颞上回(MNI:X,Y,Z=63,3,−3)、左侧颞上回(MNI:X,Y,Z=−54,−12,3)FC减弱;以右距状裂周围皮层为种子点,与左侧舌回(MNI:X,Y,Z=−33,−87,−15)FC减弱(P<0.001,FWE-corrected<0.05)。C+患者GMV与FC值与心理认知结果之间未存在明显相关性(P>0.05)。结论乳腺癌患者化疗后大脑部分区域GMV改变,与大脑多个脑区存在FC受损,这可能是其认知、情感及行为障碍的神经病理基础之一。

Objective:To investigate the changes of gray matter volume(GMV)and functional connectivity(FC)of some brain regions in patients with breast cancer undergoing chemotherapy.Materials and Methods:The study included 29 patients with breast cancer before chemotherapy treatment(C−)and 30 patients with breast cancer after chemotherapy treatment(C+).We performed psychological cognitive testing,structural and resting functional MRI(fMRI)scans respectively.Voxel-based morphometry(VBM)was used to analyze GMV,and the regions with volumetric variation were selected as regions of interest interest(ROI)for whole-brain FC analysis.Results:Compared with the C−group,patients with C+had reduced GMV in the left middle occipital gyrus(MNI:X,Y,Z=−10.5,−105.0,0.0)and the right calcarine fissure and surrounding cortex(MNI:X,Y,Z=15.0,−103.5,−1.5).With the left middle occipital gyrus as the seed point,the FC with the temporal pole:superior temporal gyrus(MNI:X,Y,Z=63,3,−3)and the left superior temporal gyrus(MNI:X,Y,Z=−54,−12,3)was weakened.With the right calcarine fissure and surrounding cortex as the seed point,the FC with the left lingual gyrus(MNI:X,Y,Z=−33,−87,−15)was weakened.There was no significant correlation between GMV and FC values and psychological cognitive outcomes in C+patients.Conclusions:After chemotherapy,the volume of gray matter in some brain regions of breast cancer patients is changed,and FCs with multiple brain regions are impaired,which may be one of the neuropathological bases of cognitive,emotional and behavioral disorders.