Multimodal magnetic resonance imaging study of brain structure and function changes in patients with knee osteoarthritis
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摘要:
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。 -
关键词:
- 膝骨性关节炎 /
- 基于体素的形态学测量 /
- 静息态功能磁共振成像 /
- 低频振幅 /
- 功能连接
Abstract: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. -
图 1 KOA组与HC组VBM值差异脑图（冷色代表KOA组灰质体积低于HC组的脑区）
SPL: 顶上小叶; V1: 初级视觉皮层; MTC: 颞中回; PCUN: 楔前叶.
Figure 1. Brain map of the difference in VBM value between KOA group and HC group (Cool colors represent brain regions where the gray matter volume of KOA group is lower than that of HC group).
图 2 KOA组与HC组ALFF值差异脑图（暖色代表KOA组神经元活性高于HC组的脑区，冷色代表KOA组神经元活性低于HC组的脑区）
MFC: 额中回; mPFC: 内侧前额叶皮层.
Figure 2. Brain map of the difference in ALFF value between KOA group and HC group (Warm colors represent brain regions with higher neuronal activity in KOA group than HC group, cool colors represent brain regions with lower neuronal activity in KOA group than HC group).
图 3 KOA组与HC组功能连接差异脑图（暖色代表KOA患者FC值高于健康人的脑区，冷色代表KOA患者FC低于健康人的脑区）
ACC: 前扣带回; dlPFC: 背外侧前额叶皮层.
Figure 3. Brain map of the difference in FC value between KOA group and HC group (Warm colors represent brain regions with higher FC value in KOA group than HC group, cool colors represent brain regions with lower FC value in KOA group than HC group).
表 1 两组受试者一般资料比较
Table 1. Comparison of baseline data between two groups of subjects (n=30, Mean±SD)
组别 性别（n） 年龄（岁） 受教育时间（年） 身高（m） 体质量（kg） 男 女 KOA组 6 24 57.40±9.95 10.20±2.73 1.65±0.05 63.67±8.22 HC组 5 25 58.70±10.04 10.10±2.76 1.64±0.05 65.27±9.45 t/χ2 0.111 0.254 0.141 0.206 0.489 P 0.739 0.616 0.888 0.838 0.487 KOA: 膝骨性关节炎; HC: 健康对照. 
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表 2 KOA组与HC组VBM值显著差异脑区信息
Table 2. Brain region information of significant difference in VBM value between KOA group and HC group
AAL脑区 大脑半球 MNI坐标 BA分区 团块大小
（体素数）t X Y Z 楔前叶 R 3 -63 33 7 602 -3.49 颞中回 L -48 -3 -21 21 230 -3.96 顶上小叶 R 36 -57 69 7 139 -3.87 中央后回 L -54 -9 -18 20 62 -3.27 初级视觉皮层 R 15 -87 3 17 666 -3.92 L: 左; R: 右; AAL: 解剖学自动标记; BA: 布罗德曼分区; MNI: 蒙特利尔神经学研究所.
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表 3 KOA组与HC组ALFF值显著差异脑区信息
Table 3. Brain region information of significant difference in ALFF value between KOA group and HC group
AAL脑区 大脑半球 MNI坐标 BA分区 团块大小
（体素数）t X Y Z 梭状回 L -33 -39 -27 37 59 4.1 梭状回 R 39 -42 -24 37 68 3.91 颞中回 R 54 -66 3 37 44 3.58 楔前叶 R 12 -63 57 7 99 -4.3 额中回 L -24 3 51 - 25 -4.66 内侧前额叶皮质 R 6 48 39 9 54 -4.6
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表 4 KOA组与HC组FC值显著差异脑区信息
Table 4. Brain region information of significant difference in FC value between KOA group and HC group
AAL脑区 大脑半球 MNI坐标 BA分区 团块大小
（体素数）t X Y Z 颞中回 R 51 -33 3 21 64 3.67 楔前叶 R 6 -69 39 7 28 -3.59 背外侧前额叶皮质 L -12 45 48 9 52 -3.47 前扣带回 L -3 51 0 10 41 -3.13
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