使用靜息態功能性磁振造影探討無預兆偏頭痛患者腦部疼痛相關腦區之功能性連結變化

The Alterations of Pain-Related Brain Regions Functional Connectivity in Migraine without Aura by Using Resting-State Functional MRI

陳奕筑(YI-CHU CHEN)

指導教授 ： 周銘鐘

高雄醫學大學/健康科學院/醫學影像暨放射科學系碩士班/碩士(2020年)

摘要

研究目的：
疼痛的感覺是由大腦中的疼痛基質(Pain Matrix)相關腦部區域來執行，有相關研究指出頭痛相關病症會影響疼痛基質的活躍度。
近年來研究方向開始將磁振造影應用在腦部神經血液活動研究，而靜息態功能性磁振造影(rsfMRI)因為可以在受試者休息狀態下做研究的特性下而受到大腦研究者青睞。
因此本研究旨在利用rsfMRI分析觀察偏頭痛病患與正常人之間在疼痛基質相關腦區在休息狀態功能性連結是否出現差異。
材料與方法：
本研究使用Siemens 3.0T Skyra System，我們收集了38名受試者，其中19位非預兆性偏頭痛受試者(男/女：5/14；年齡平均值41.5±10.94)及19名正常控制組受試者(男/女：9/10；年齡平均值38.6±12.58)，各自收集T1權重3D影像和靜息態功能性磁振造影影像，再經由影像分析軟體Conn的功能性連結分析出兩組受試者疼痛基質相關區域的差異。使用雙樣本t檢定(Two-Sample T-Test)檢驗兩組樣本的平均值是否有差異，並且使用False Discovery Rate的p-FDR<0.05來對所有靜息態功能性連結進行多次的比較與校正。

結果：
根據研究結果看來，跟健康控制組相比，偏頭痛患者在整體疼痛基質的腦區功能性連結相對有減少的情形。
偏頭痛患者跟健康控制組相比功能性連結減少的區域有：左腦島、右海馬迴、初級感覺皮質中的右中央後迴、主要運動區的左中央前迴、前額葉中的右額極、左額中迴跟眼額區，功能性連結增加的區域則有：大腦導水管旁灰質、腦幹、後扣帶迴、次級感覺皮質中的左頂葉島蓋跟前額葉中的胼胝體下皮層。
結論：
偏頭痛患者經過長期頭痛的影響，在休息狀態下，腦內的區域產生了功能性連結部分區域產生不同的變化，這些變化會影響偏頭痛患者的中樞神經過度敏感以及舒緩對疼痛的感受，但這些變化會對疾病有不好的後續影響，這些結論可以協助醫生診斷偏頭痛的病灶。

關鍵字

偏頭痛 ； 疼痛基質 ； 靜息態功能性磁振造影 ； 功能性連結

並列摘要

Purpose：
Pain sensation is performed by brain regions related to pain matrix in the brain. Some studies indicated that headache-related symptoms can affect the activity of the pain matrix. In recent years, research has begun to use magnetic resonance imaging to study with brain activation, and resting state functional magnetic resonance imaging (rsfMRI) is favored by researchers because of the properties that the examination can be done when the subject is resting.
Therefore, the aim of our study is to use rsfMRI to observe whether pain matrix has a difference of activity and functional connection between the migraine patients and normal subjects in the pain-related brain regions at resting state.
Materials and Methods：
We enrolled 38 subjects, including 19 migraine without aura (MWoA) subjects (M/F=5/14, age=41.5±10.94 y/o) and 19 normal control subjects (M/F=9/10, age=38.6±12.58 y/o). All subjects received T1 weighted 3D MRI and rsfMRI images on a 3.0T System (Skyra, Siemens, Erlangen, Germany). The data were analyzed by Conn toolbox to understand the difference of functional connectivity between migraine and control groups. Two-sample t test was performed to compare the difference between the two groups with false discovery rate (FDR) correction, and results were considered significant if pFDR < 0.05.

Results：
The results of the study showed that, compared with the health control group, migraine patients have lower functional connectivity in the pain matrix, and regions of lower functional connectivity in patients include left insula, right hippocampus, right posterior central gyrus of the primary somatosensory cortex, left central anterior gyrus of the primary motor cortex, prefrontal cortex (right frontal pole, left middle frontal gyrus and orbitofrontal area) , and regions of higher functional connectivity in patients include periaqueductal gray, brainstem, posterior cingulate cortex, left parietal operculum cortex of secondary somatosensory cortex and subcallosal cortex in prefrontal cortex
Conclusions：
In long-term headache, migraine patients have different changes in functional connectivity of the brain area in rest. These changes may affect the central nervous system's oversensitivity and relieving the pain, but may have negative effects on the disease that can help doctors in diagnosis of migraine.

並列關鍵字

Migraine ； Pain Matrix ； rsfMRI ； Functional Connectivity

參考文獻

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