Cerebral blood flow in patients with primary dysmenorrhea by arterial spin labeling technique
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摘要:
目的 采用基于体素的形态学方法及动脉自旋标记技术，探讨原发性痛经（PDM）患者的脑血流量变化，并分析其与临床量表评分的相关性。 方法 前瞻性纳入陕西中医药大学被确诊为PDM的患者31例作为PDM组，另选取同期32例健康者作为健康对照组，在月经期第1~3天进行高分辨率T1结构像及全脑动脉自旋标记扫描，并采用疼痛视觉模拟量表（VAS）、COX痛经症状量表（CMSS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）进行临床症状评估。采用基于体素的形态学方法，基于Matlab平台的SPM8软件的双样本t检验分析两组间脑血流量差异有统计学意义的脑区，再采用Pearson相关性分析，观察脑血流量差异脑区的脑血流量值与VAS、CMSS、SAS、SDS量表评分之间的相关性。 结果 PDM组与健康对照组在年龄、VAS、CMSS、SAS、SDS量表评分的差异均有统计学意义（P < 0.05）。与健康对照组相比，PDM组脑血流量增高的脑区主要包括左侧三角部额下回，脑血流量减低的脑区包括右侧眶部额上回、右侧眶部额中回、右侧扣带回前部（P < 0.005，团块水平FDR校正，k≥100）。相关性分析结果显示左侧三角部额下回脑血流量值与VAS、CMSS总发作时间量表评分存在正相关（P < 0.05）。 结论 基于动脉自旋标记技术及基于体素的形态学方法能够评估PDM患者的脑血流灌注水平，这些脑血流量改变的脑区主要位于痛觉传导通路，为PDM患者的诊治提供有价值的信息。 Abstract:Objective To explore the changes of cerebral blood flow in patients with primary dysmenorrhea (PDM) and analyze the correlation between them and clinical scale scores by using voxel-based morphological methods and arterial spin labeling technology. Methods Thirty-one patients diagnosed as PDM in Shaanxi University of Traditional Chinese Medicine were prospectively enrolled as PDM group, and 32 healthy people were selected as healthy control group. On the 1st to 3rd day of menstrual period, high-resolution T1 structural images and whole brain arterial spin labeling scans were performed, and the clinical symptoms were evaluated by visual analogue scale for pain (VAS), COX dysmenorrhea symptom scale (CMSS), selfrating anxiety scale (SAS) and self-rating depression scale (SDS). Using voxel-based morphometry method, the double-sample t test of SPM8 software based on Matlab platform was used to analyze the brain regions with significant differences in cerebral blood flow between the two groups, and then Pearson correlation analysis was used to observe the correlation between the cerebral blood flow value of the brain regions with different cerebral blood flow and the scores of VAS, CMSS, SAS and SDS scales. Results There were significant differences in age, VAS, CMSS, SAS and SDS between PDM group and healthy control group (P < 0.05). Compared with the healthy control group, the brain regions with increased cerebral blood flow in PDM group mainly included the left triangular inferior frontal gyrus, while the brain regions with decreased cerebral blood flow included the right orbital superior frontal gyrus, anterior part of right cingulate gyrus and the right orbital middle frontal gyrus (P < 0.005, corrected by FDR of mass level, k≥100). Correlation analysis showed that the cerebral blood flow value of the left triangle inferior frontal gyrus was positively correlated with the scores of VAS and total attack time of CMSS(P < 0.05). Conclusion Based on arterial spin labeling technology and voxel-based morphometry method, the cerebral blood flow perfusion level of patients with primary dysmenorrhea can be evaluated. These brain regions with changes in cerebral blood flow are mainly located in pain conduction pathways, which provides valuable information for the diagnosis and treatment of patients with primary dysmenorrhea. -
Key words:
- primary dysmenorrhea /
- arterial spin labeling /
- cerebral blood flow
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图 1 痛经组与健康对照组脑血流量差异的脑区分布（红色区域为脑血流量增加的脑区，蓝色为脑血流量减低的脑区）
Figure 1. Distribution of brain regions with different cerebral blood flow between dysmenorrhea group and healthy control group (red region was the brain region with increased cerebral blood flow, and blue region was the brain region with decreased cerebral blood flow).
图 2 PDM组与健康对照组脑血流量差异脑区CBF值与VAS、CMSS总发作时间量表评分之间的相关性
Figure 2. Correlation between CBF value and VAS, CMSS total attack time scale score of PDM group and healthy control group.
表 1 PDM组与健康对照组临床资料比较
Table 1. Comparison of clinical data between PDM group and healthy control group (n=63)
Clinical data PDM group Health group t/Z P Age [year, M(P25, P75)] 23（21, 25） 25（24, 26） -2.42 0.02 Height (cm, Mean±SD) 162.77±5.58 160.41±4.36 1.88 0.07 Body mass (kg, Mean±SD) 51.95±6.26 53.16±6.31 0.78 0.45 Course of disease [year, M(P25, P75)] 5（4, 8） 0（0, 0） -7.32 < 0.01 VAS [M(P25, P75)] 7（5, 8） 1（0, 2） -6.87 < 0.01 CMSS total attack time [M(P25, P75)] 20（14, 25） 4（2, 6） -6.12 < 0.01 CMSS average severity [M(P25, P75)] 15（11, 23） 4（2, 6） -6.29 < 0.01 SAS [M(P25, P75)] 35（28, 40） 24（23, 29） -4.60 < 0.01 SDS [M(P25, P75)] 34（29, 45） 28（24, 32） -3.51 < 0.01 PDM: Primary dysmenorrhea; VAS: Visual analogue scale; CMSS: COX dysmenorrhea symptom scale; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale. 
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表 2 两组受试者脑血流量差异脑区分布
Table 2. Difference of cerebral blood flow between two groups and distribution of brain regions
Brain region Hemisphere Lump/voxel MNI coordinate T X Y Z Inferior frontal gyrus of triangle L 334/132 -54 16 36 3.72 Orbital frontal gyrus R 1298/187 8 40 -4 -3.82 Orbital middle frontal gyrus R 1298/429 8 40 -4 -3.82 Anterior cingulate gyrus R 1298/109 8 40 -4 -3.82 P < 0.005, FDR correction of lump level, voxel k≥100.
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