| Background and Purpose:Migraine is a common type of primary headache,depending on whether the presence of visual,auditory and other aura symptoms are divided into migraine without migraine(MWo A)and aura migraine(MWA).With the survival environment and living conditions change,the incidence of migraine has an upward trend,the population incidence rate has reached 10%,the Chinese people with no aura migraine-based,and there is a clear family clustering,the clinical features is the side or bilateral temporal recurrence of pulsatile headache,before the onset may be accompanied by visual,somatosensory signs,attack usually accompanied by nausea or \ and vomiting.Recent studies have shown that migraine can have a serious impact on the quality of life of patients,more than half of patients will affect daily life and work,more than three percent of patients may be due to lack of headache or absent.Migraine may be a progressive disease,constant recurrent episodes and may lead to increased risk of heart and cerebrovascular disease,and may increase the risk of some brain lesions and may lead to certain brain regions Nerve damage.The World Health Organization(WHO)World Health Report ranked common disease for Years Lived with Disability(YLD)in 2001,with top 20 migraine headings and severe migraine as similar to dementia,Limb paralysis and severe mental illness of the most disabled chronic diseases.However,the pathogenesis of migraine is not yet clear,there are vascular theory,neurological theory and trigeminal neurovascular theory and several hypotheses.The diagnosis of migraine is mainly based on the clinical symptoms described by the patient,refer to the International Headache Association International Headache Disease Classification Standard-Ⅲβ(ICHD-Ⅲβ)and the relevant scale,no relevant objective biochemical indicators and imaging basis.In recent years,with the development of imaging technology,the researchers used a variety of imaging techniques to observe the migraine headache cortex,cingulate gyrus,insular,thalamus and other microstructure damage and functional abnormalities,these areas are mainly involved in the central nerves on the regulation of pain.Functional and structural magnetic resonance imaging techniques are also increasingly used in migraine research.Restorative functional magnetic resonance imaging(rs-fMRI)is a technique used to study the spontaneous activity of the brain function network without performing specific activity tasks in the brain reference control state.At present,the study of clinical neuropsychiatric mental illness is widespread application.Structural magnetic resonance imaging(MRI)provides a visual and intuitive anatomical evidence for the hypothesis of anatomical structures(cortex thickness,volume,surface area,curvature,etc.).The study is divided into three parts.The first part is the study of the local consistency of the brain in patients with migraine without aura.The second part is the study of the cortical thickness of the whole brain gray matter in patients with migraine without aura.The third part is the study of the functional connection between the ROI brain and the whole brain in the difference function and structure of the first and the second parts.To investigate the changes of brain function,brain structure and brain network in migraine patients by MWMA patients,the spontaneous activity of brain neurons in patients with episodes of MWo A was analyzed,and the clinical data of these patients were compared with those of MWoA patients And to understand the possible neuroimaging mechanism of MWoA from function,structure and network multimodal,and to provide clues for the pathogenesis of MWoA,and to provide objective and specific imaging basis for clinical diagnosis of MWo A.Materials and Methods:A total of 49 patients with MWo A confirmed by experts in the clinic of the Department of Neurology,the First Affiliated Hospital,the Third Military Medical University,China,between November 2014 and December 2015 were recruited.During follow-up,one case exhibited right-sided migraine pain 3 days after scanning and was excluded from the study.Finally,48 cases were enrolled.A total of 48 volunteers recruited from communities were used as the normal control group,all healthy controls are not relatives of migraine patients and that they do not complain migraine criteria.There were 48 subjects in both the MWoA patient and healthy control groups.The gender,age,and education level of the subjects did not differ significantly between these two groups(P>0.05).All MRI data(including T2 WI,3D-T1 and rs-fMRI imaging)were performed with 3.0-Tesla MR scanner(Trio Tim system;Siemens,Erlangen,Germany)at the Department of Radiology,the First Affiliated Hospital,the Third Military Medical University.Firstly,The ReHo maps within and between two groups were compared using t-test with the FEW correction(P < 0.01,clusters > 85).The correlations between the ReHo values of the brain regions that showed differences and clinical variables such as the duration of the disease course were analyzed by Pearson analysis.All the statistical analyses were performed via SPSS version 22.0 software.Then 48 cases of MWo A patients and strict matching of HC subjects in 48 cases of 3D high-resolution structural images of cortex thickness analysis.In the Linux system to run FreeSurfer software,the left and right hemispheres were analyzed,the steps are as follows:(1)non-brain tissues such as the skull were removed;(2)optimal linear conversion was performed to calculate the maximum likelihood of the atlas template corresponding to whole-brain tissue images;(3)non-linear conversion was performed to convert images into the standardized Talairach space;(4)whole-brain gray and white matter segmentation was performed;(5)the signal intensities of the gray and white matter after segmentation were standardized;(6)topological correction of the surface of gray and white matter after segmentation was performed;(7)the boundary of the gray and white matter surface after segmentation was defined;(8)the mean thickness of a total of 148 brain regions corresponding to 74 regions in each of the left and right hemispheres,set up using the aparc.a2009 s template,was calculated.Approximately 16 h was required for the analysis of each patient.Finally,Brat 1.0 software was used to analyze the functional connection(FC)of seed point and whole brain.In this study,the brain area(insular sub-regions)with significant difference between ReHo and cortex thickness in the previous two experiments was seed point FC analysis of brain insular sub-region and whole brain.Then the Fisher Z-score trans-formation was used to transform the Pearson correlation coefficient r value into the z value which represent functional strength between the ROI and each voxel.The differences in functional connectivity between HC group and MWoA group were compared via REST1.8 software package(FWE correction,P < 0.05,voxel size > 85).Finally,extract z values of MWo A group with difference brain areas and correlation analysis was performed with the duration of the disease course.Results:1.Re Ho Results:Compared with HC group,the increase of Re Ho value in MWoA group was as follows: ReHo increase was observed in the bilateral anterior cingulate cortex,bilateral rectus gyrus,insular,right precuneus,right posterior cingulate cortex,right inferior parietal lobule,right middle temporal gyrus,right superior temporal gyrus.Compared with HC group,the reduction of Re Ho in the MWoA group was as follows: the bilateral supplementary motor area,double side paracentral lobule,right medial frontal gyrus,left dorsal anterior cingulate cortex,left limbic lobe.The results of correlation analysis showed that in MWo A group,the Re Ho values of right anterior cingulate,right precuneus,left and right insula were negatively correlated with the duration of the disease,and the correlation coefficients were r =-0.457,r =-0.524,r =-0.717,r =-0.683,respectively.2.Cortex Thickness Results:Compared with the HC group,the reduction of thickness in the MWo A group was as follows: the bilateral insula,bilateral cuneus,bilateral cortex surrounding the corpus callosum,left calcarine gyrus,Cingulate(bilateral dorsal anterior cingulate,bilateral posterior cingulate,bilateral anterior cingulate),Frontal(bilateral orbitofrontal gyrus,bilateral middle frontal gyrus,right dorsolateral frontal gyrus),Temporal(bilateral middle temporal gyrus,right inferior temporal gyrus),Parietal(bilateral paracentral lobule,bilateral postcentral gyrus,bilateral inferior parietal lobule,bilateral precentral gyrus),Occipital(bilateral superior occipital gyrus,left middle occipital gyrus).No brain of thickness increased was found.Pearson correlation analysis was performed on brain regions and duration duration with statistically significant differences in mean thickness.It was found that the average thickness of the cortex was positively correlated with the duration of the course(rl = 0.618,rr = 0.660).The average thickness of the cortex in the upper part of the insular was negatively correlated with the duration of the course(rl =-0.863,rr =-0.685).The average thickness of the cortex in the lower part of the insular was negatively correlated with the duration of the course(rl =-0.926,rr =-0.627).3.Functional connectivity Results:Compared with the HC group,the different functional connectivity regions of the MWoA group between the insular sub-region and whole brain:(1)the left granule insular(L-G)as the seed point,right fusiform,right precuneus,right angular function connection to reduce,the right middle cingulum,left caudate function connection increased.(2)The right granular insular(R-G)was used as seed point,left fusiform,left middle cingulum,and the functional connection of the right caudate were increased.(3)left ventral no granular insular(L-v Ia)as the seed point,left thalamus,left posterior cingulate function connected to reduce,left middle occipital,middle frontal and inferior parietal function connection were increased.(4)the right ventral no granular insular(R-v Ia)as a seed point,left fusiform,right caudate,right middle temporal gyrus,right precuneus and right inferior parietal function connection to reduce,the functional connection of the right thalamus increased.(5)the left dorsal side of the non-granular insular(L-d Ia)as a seed point,right parahippocampal,left fusiform gyrus,precuneus and left cuneus function decreased,left temporal pole and middle function connection to reduce.(6)the right dorsal side of the non-granular insular of the insular(R-d Ia)as a seed point,right parahippocampal,right inferior temporal gyrus,right occipital middle,right cingulum middle,superior parietal function connection to reduce,right caudate functional connection was increased.(7)left ventral absent granular / granular insular(L v Id / v Ig)as the seed point,left fusiform gyrus and superior temporal function connection were decreased,the left thalamic function connection was increased.(8)right ventral absurd granular / granular insular(R-v Id / vIg)as seed point,right orecuneus,right parahippocampal,right cuneus,right cingulum middle,right parietal inferior function connection were decreased;no brain functional connection to increase.(9)left dorsal granule insular(L-dIg)as seed point,left superior temporal gyrus,left temporal inferior gyrus,left temporal suoerior,left posterior cingulate gyrus,right parietal inferior,right medial cingulum gyrus functional connection were reduced,the function of the right caudate nucleus is increased.(10)on the right dorsal side of the granular insular of the insular(R-d Ig),left inferior temporal gyrus,right lingual,right supplementary motor area and left parietal inferior function connection were decreased,left frontal superior and medial function connection was increased.(11)left atriplex atypical granular insular(L-d Id)as a seed point,right inferior temporal gyrus,right cingulum middle gyrus and right supplementary motor area functional connection were decreased,right caudate nucleus and right frontal superior and medial function connection were increased.(12)the right dorsal atypical granular insular(R-d Id)as a seed point,the right precuneus and right precentral function connection were decreased,the right frontal superior and medial function connection were increased.The z-Score values of the brain insular subduction area of the MWoA patients were lower than those of the healthy control group.The statistically significant brain-insular area had L / R-vIa,L / R-d Id,R-d Ia,R-d Ig,and the linear regression analysis of these statistically significant brain regions showed that these brain regions were negatively correlated with duration of disease,that is,MWoA patients the z-Score of these brain-insular sub-regions with the course of the variable length function is gradually reduced.Conclusion:1.In the first part of the study,we used local consistency analysis to find that the default network-related brain regions were active in the subjective feelings and pain sensory responses of migraine,the marginal system-related brain regions were active in the medial pain pathways of migraine the formation of pain,on the other hand involved in the modulation of pain,so that increased pain threshold,highlight the network-related brain negative activation,on the one hand weakened the pain response and memory,on the other hand because of its analgesic effect weakened lead to migraine.2.In the second part of the whole brain gray matter cortical thickness of the study we found that: the default network-related brain area of the average cortical thickness reduction,may be related to the nervous system adaptive,through the nervous system itself attenuation,on the one hand as much as possible to reduce the Pain on the emotional response and subjective feelings,on the other hand to take the initiative to reduce the pain and other sensory function response;edge system-related brain area of the average cortical thickness reduction,on the one hand the edge of the network involved in migraine pain in the formation of pain,Pain modulation,the pain threshold increased;highlight the network-related brain area average cortical thickness reduction,on the one hand,the regulation of the pain response to the attention and memory,on the other hand because of its analgesic effect weakened lead to migraine.Insular can integrate internal and external stressors to maintain antagonistic balance.As the duration of the duration of the disease increases,the thickness of the posterior insular of the brain falls less rapidly to reduce the pain sensation input to the forebrain insular,whereas the forebrain insular average cortex The thickness reduction is slower to increase the emotional and cognitive treatment of pain to keep the whole brain network in a dynamic equilibrium.3.In the third part of the study,we found that vIa,v Id / v Ig and dIa sub-regions were mainly involved in the emotional regulation of migraine,and G,dIg,dId sub-regions were associated with sensory and cognition of pain sensation,most of the functional connections of the insular sub-regions and the whole brain appear obvious lateral and right superiority with the seed point,L / R-vIa,L / R-d Id,R-dIa,R-dIg sub-region and the whole brain of the functional connection strength with the duration of the process gradually decreased,indicating that MWo A is a progressive disease.In summary,the results of this study suggest that MWo A patients not only have extensive brain function abnormalities,there are clear changes in gray matter structure,and this brain function and structural changes and duration of the disease is closely related to the discovery of MWo A The diagnosis,treatment and prognosis provide strong imaging evidence... |
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