靜息態功能性磁振造影於化療前後乳癌病患腦部變化之探討

研究目的：本研究希望藉由結合腦部靜息態功能性磁振造影 (resting state-functional MRI, rs-fMRI) 與神經心理學測試，探討乳癌患者認知功能障礙潛在機制，並試著找出受影響腦區與量表的相關性。研究方法及資料：本研究募集包括無接受化療的乳癌患者 (BC)、化療完成後6至12個月內的乳癌患者 (BC_Tx) 和健康對照組 (HC) 等3組參與者。所有參與者接受腦部rs-fMRI掃描與神經心理學測試，包括簡短智能測驗 (Mini-Mental State Examination, MMSE)、認知情感正念量表-修訂版 (Cognitive and Affective Mindfulness Scale-Revised, CAMS-R)、醫院焦慮憂鬱量表 (Hospital Anxiety and Depression Scale, HADS) 和事件影響量表-修訂版 (Impact of Event Scale-Revised, IES-R)。rs-fMRI掃描得到的影像資料經過一系列的前處理後，以平均分率低頻振幅波動 (mean fractional amplitude of low-frequency fluctuation, mfALFF) 和平均區域同質性 (mean regional homogeneity, mReHo) 兩種分析方式來比較三組參與者的差異，並進一步將影像分析資料與神經心理學測試結果做相關性分析。研究結果：本研究總共招募110位參與者（BC組32位、BC_CTx組32位、HC組46位）。使用mfALFF分析發現，在額頂葉中，BC組大於BC_CTx組，而BC_CTx組大於HC組；在枕葉中，HC組和BC_CTx組之間無顯著差異，但都大於BC組。使用mReHo分析發現，在額頂葉中，HC組大於BC_CTx組，BC_CTx組大於BC組。這些受影響腦區分布於注意力相關的神經網絡。在神經心理學測試相關性分析中發現，mfALFF與MMSE和CAMS-R的分數在枕葉呈現正相關，在額頂葉呈現負相關；mfALFF與HADS和IES-R的分數在額頂葉呈現正相關，在枕葉呈現負相關。mReHo與MMSE和CAMS-R的分數在額頂葉呈現正相關；mReHo與HADS和IES-R的分數在額頂葉呈現負相關。結論與建議：在我們使用rs-fMRI研究中發現，乳癌患者在化療前注意力網絡功能性連結就有顯著的改變，這樣的改變甚至比化療後來的明顯，並與神經心理測試的變化相關。我們建議結更多面向的MRI檢查與神經心理測試做進一步前瞻性縱向式的相關研究。

關鍵字

乳癌；化療；靜息態功能性磁振造影；注意力網絡

並列摘要

Objective：This study tried to figure out possible underlying mechanism of breast cancer associated cognitive disorder by using resting-state functional MRI (rs-fMRI) and neuropsychological tests. Methods and Materials：This study enrolled 3 groups of participants, including breast cancer without chemotherapy (BC), breast cancer within 6 to 12 months after chemotherapy (BC_CTx) and healthy controls (HC). The participants underwent rs-fMRI scan and neuropsychological tests, including Mini-Mental State Examination (MMSE), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R). After preprocessing of rs-fMRI data, mean fractional amplitude of low-frequency fluctuation (mfALFF) and mean regional homogeneity (mReHo) were used for groups comparison and further association study between rs-fMRI and neuropsychological tests were performed. Results：This study totally enrolled 110 participants, including 32 BC, 32 BC_CTx and 46 HC. In mfALFF analysis, BC showed greater mfALFF than BC_CTx, and BC_CTx showed greater mfALFF than HC in the frontoparietal lobe. HC and BC_CTx showed no significant mfALFF difference, but both showed greater mfALFF than BC in the occipital lobe. In mReHo analysis, HC showed greater mReHo than BC_CTx, and BC_CTx group showed greater mReHo than BC in the frontoparietal lobe. The above results indicated attention network involvement. In neuropsychological tests association analysis, MMSE and CAMS-R scores showed a positive correlation in the occipital lobe and a negative correlation in the frontoparietal lobe with mfALFF. In contrast, HADS and IES-R scores showed a positive correlation in the frontoparietal lobe and a negative correlation in the occipital lobe with mfALFF. MMSE and CAMS-R scores showed a positive correlation in the frontoparietal lobe with mReHo. In contrast, HADS and IES-R scores showed a negative correlation in the frontoparietal lobe with mReHo. Conclusion and Suggestion：In this rs-fMRI study, we found attention network associated brain areas alterations in the breast cancer patients before chemotherapy, which even more prominent than in the patients after chemotherapy and associated with neuropsychological distress. We recommend that further prospective longitudinal studies using comprehensive MRI with neuropsychological test correlations are necessary.

並列關鍵字

breast cancer ； chemotherapy ； resting state-functional MRI ； attention network

參考文獻

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靜息態功能性磁振造影於化療前後乳癌病患腦部變化之探討

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