The MRI Study Of Morphology And Function Of Brain In Patients With Cervical Spondylotic Myelopathy

Part I Morphological MRI Study of Brain Gray Matter in Patients with Cervical Spondylotic MyelopathyObjective:This study aims to precisely investigate the significant changes in brain gray matter volume and cortical features in patients with cervical spondylotic myelopathy(CSM)using magnetic resonance imaging(MRI)based on the automated anatomical labeling(AAL)brain atlas.It also explores the relationship between differential brain regions and clinical parameters of CSM patients.Methods:The study included 66 CSM patients and 76 matched healthy controls,undergoing MRI structural imaging.Voxel-based morphometry(VBM)and Surface-based morphometry(SBM)methods were utilized to identify significant changes in gray matter volume(GMV)and cortical features in the CSM patient group.The correlation between the indices of differential brain regions and disease duration,Japanese Orthopaedic Association(JOA)score,and its sub-scores were evaluated.Results:Compared to the healthy control group,the CSM patients exhibited significant reductions in GMV in areas such as the right cerebellar lobule VIII,left middle temporal gyrus,and increases in the bilateral anterior cingulate cortex,left orbitofrontal gyrus.Cortical thickness significantly decreased in the right inferior frontal gyrus pars triangularis;cortical surface area significantly reduced in the right precentral gyrus and right superior frontal gyrus.The cortical curve significantly lowered in the left temporal pole,right fusiform gyrus,right parahippocampal gyrus;cortical curve significantly decreased in the left middle temporal gyrus,left posterior middle frontal gyrus,right postcentral gyrus,right superior frontal gyrus,and right superior parietal lobule,but significantly increased in the left superior marginal gyrus,bilateral precentral gyrus.Correlation analysis revealed significant associations between gray matter changes in certain brain regions and clinical parameters in CSM patients,most notably,a negative correlation between GMV and cortical curve in the left middle temporal gyrus with disease duration,and a positive correlation with JOA score,upper limb motor ability,sensory function,and bladder control ability.Conclusion:The findings suggest that CSM patients exhibit significant changes in brain GMV and cortical features compared to healthy individuals,such as a significant decrease in GMV in the right cerebellar lobule VIII and a significant increase in the bilateral anterior cingulate cortex.Changes in certain differential brain regions,especially the left middle temporal gyrus,are closely related to the disease duration and functional impairment in CSM patients.The GMV and cortical curve of the left middle temporal gyrus may serve as therapeutic targets for CSM,suggesting that targeted restoration of the specific brain region’s gray matter structure could optimize treatment outcomes.Part II Multi-modal Diffusion Imaging MRI Study of Brain White Matter in Patients with Cervical Spondylotic MyelopathyObjective:This study aims to utilize multi-b value diffusion-weighted MRI sequences and multi-model diffusion techniques to precisely investigate the significant changes in brain white matter tracts in patients with CSM,and to explore the relationship between differential white matter tracts and clinical parameters of CSM patients.Methods:The study included 44 CSM patients and 44 matched healthy controls,undergoing multi-b value diffusion-weighted MRI imaging.Tract-based spatial statistics(TBSS)analysis of diffusion tensor imaging(DTI),diffusion kurtosis imaging(DKI),and neurite orientation dispersion and density imaging(NODDI)were used to identify significant changes in diffusion metrics of white matter tracts in the CSM patient group.The correlation between the metrics of differential brain regions and disease duration,JOA score,and its sub-scores were evaluated.Results:Compared to the healthy control group,CSM patients showed significant reductions in FA values in the corpus callosum forceps minor,right inferior fronto-occipital fasciculus,left corticospinal tract;increased RD values in the corpus callosum forceps minor,left cingulum,bilateral superior longitudinal fasciculus;decreased FK values in the right inferior longitudinal fasciculus,right superior longitudinal fasciculus;decreased RK values in the left cingulum,right inferior fronto-occipital fasciculus,left inferior longitudinal fasciculus,bilateral inferior frontooccipital fasciculus;decreased NDI values in the left cingulum,right anterior thalamic radiation;and increased ODI values in the right uncinate fasciculus.Correlation analysis revealed significant associations between changes in white matter tracts in certain differential brain regions and clinical parameters in CSM patients,notably changes in RD/RK/NDI values in the left cingulum,with RK values positively correlating with JOA score and bladder control function score,and NDI values positively correlating with JOA score,upper limb motor function score,and sensory function score.Conclusion:The findings indicate that CSM patients exhibit significant changes in brain white matter tracts compared to healthy individuals.Changes in certain differential brain regions,especially the left cingulum,are closely related to the disease duration and functional impairment in CSM patients.RK/NODDI metrics of the left cingulum white matter tracts may serve as potential imaging biomarkers for CSM,assisting in the development of personalized rehabilitation plans and evaluating disease treatment outcomes.Part Ⅲ Graph Theory and Dynamic Connectivity MRI Study of Brain Function in Patients with Cervical Spondylotic MyelopathyObjective:This research focuses on employing graph theory analysis and dynamic functional connectivity(d FC)techniques to thoroughly investigate significant alterations in the brain functional networks of CSM patients and to explore the relationship between these network changes and clinical variables in CSM patients.Methods:The study enrolled 60 CSM patients and 60 matched healthy controls,all undergoing blood oxygenation level dependent(BOLD)functional MRI imaging.Graph theory analysis was utilized to identify significant changes in both global and local attributes of the brain functional networks of CSM patients.d FC edge analysis was applied to examine the notably altered functional connections between brain regions,and the correlation of these differential brain areas and functional connections with the disease course,JOA score,and its sub-scores were evaluated.Results:No substantial differences were observed in the global properties between the two groups.Compared to healthy controls,the CSM patient group exhibited a notable decrease in Dc value in the right cerebellum lobule VIII;a significant increase in NCp value in the left middle temporal gyrus;an increased Ne value in the left gyrus rectus,and bilateral anterior cingulate;a heightened NLe value in the left olfactory cortex and left middle temporal gyrus;and a reduced NLp value in the bilateral anterior cingulate.Additionally,there was a marked weakening in the functional connectivity between the left olfactory cortex and the medial part of the left superior frontal gyrus,between the insular part of the right inferior frontal gyrus and the right angular gyrus,and between the orbital part of the left superior frontal gyrus and the left middle temporal gyrus.Correlation analysis revealed that the Dc value in the right cerebellum lobule VIII and the functional connectivity between the left olfactory cortex and the medial part of the left superior frontal gyrus in the CSM group positively correlated with the JOA score,upper limb motor ability score,and sensory function score;the Ne value in the left anterior cingulate positively correlated with disease duration;and the functional connectivity between the orbital part of the left superior frontal gyrus and the left middle temporal gyrus negatively correlated with the lower limb motor ability score.Conclusion:The findings suggest that CSM patients exhibit significant alterations in the local attributes and functional connections of their brain functional networks compared to healthy individuals.Specifically,the changes in the Dc value in the right cerebellum lobule VIII,the Ne value in the anterior left cingulate,and the functional connections between the left olfactory cortex and the medial part of the left superior frontal gyrus,as well as between the orbital part of the left superior frontal gyrus and the left middle temporal gyrus,are closely associated with the course of CSM and the functional disabilities in CSM patients.Alterations in the left olfactory cortex may elucidate the potential mechanism behind the concurrent olfactory disorders in CSM.Additionally,corroborating previous studies on gray and white matter,the Ne value in the left anterior cingulate,the Nle value in the left middle temporal gyrus,and their connections with the orbital part of the left superior frontal gyrus may become crucial references in the functional assessment of CSM,potentially facilitating targeted improvements in specific brain regions to ameliorate disease-related functional impairments.