| Objective:The objective of this study was to characterize the structural and functional abnormalities of the brain in patients with primary trigeminal neuralgia(PTN)using magnetic resonance multimodal MRI,and to investigate the possible correlation between structural and functional changes and disease duration and visual analogue scale(VAS).To further investigate the pathological mechanisms of PTN and to screen potential therapeutic targets for PTN.Methods:A total of 22 patients clinically diagnosed with PTN from September 2020 to December2022 were selected as the patient group,and a total of 20 healthy controls with similar age,gender,and length of education as the PTN patient group were collected.Both groups underwent T1WI(T1 weighted imaging,T1WI)high-resolution magnetic resonance imaging(MRI)scans and resting-state functional magnetic resonance imaging(f MRI)in a calm state.Clinical data and relevant scale data were collected from both groups of subjects.The high-resolution T1 WI images were preprocessed and analyzed by voxel-based morphometry(VBM)on matrix laboratory(MATLAB)platform using SPM 12 software and CAT 12 software to obtain the white matter and gray matter parameters of the PTN patients and healthy controls.The brain areas that differed in volume between the patients and healthy controls were compared.The regions of interest(ROI)were used as the seed points,and the resting-state f MRI images were processed with SPM 12 and DAPARSF software to obtain the functional connectivity(FC)parameters between the ROI and other regions of the whole brain in the two groups.The links of brain regions with significant differences in FC values between the two groups were identified.Correlation analysis of imaging data with clinical data.The data were correlated and statistically analyzed using SPM 12 and SPSS 21.0software.Results:(1)There were 22 cases in the PTN patient group,all right-handed,including 10 males and 12 females;average age 68.68±12.42 years;average disease duration about 6.91±5.32years;average length of education 6.52±1.95 years.There were 10 patients with left-sided PTN and 12 patients with right-sided PTN.The average VAS score of the patient group was8.14±0.83.Twenty healthy controls with similar age and gender ratio and length of education as the patient group were included,all right-handed,11 males and 9 females,with an average age of 67.6±10.81 years;average length of education 6.61±2.12 years.There was no statistically significant difference in age,gender ratio and length of education between the two groups of subjects(P>0.05).hamilton depression scale(HAMD)and hamilton anxiety scale(HAMA)scale scores were at normal values in all PTN patient,and depression and anxiety were not observed.(2)Compared with the healthy control group,total gray matter volume was reduced in the PTN patients group compared with the healthy control group(P<0.05),and differences in whole brain volume and total white matter volume in PTN patients were not statistically significant(P>0.05)..The gray matter volume(GMV)in the left anterior cingulate cortex(ACC),right middle temporal gyrus,right posterior central gyrus,left hippocampus,and left superior temporal gyrus were reduced in the PTN patients compared with the healthy controls(P<0.05),and no GMV enlargement was observed.GMV in the left ACC was negatively correlated with disease duration,while GMV in other brain regions was not significantly correlated with disease duration and VAS score(P>0.05).(3)Whole-brain FC analysis was performed using the reduced GMV brain regions obtained from VBM analysis as ROI,and the FC of the left ACC with right inferior frontal gyrus(IFG),left insula,and right cerebellar Crus Ⅱ region was enhanced in the PTN patient group compared with the control group(P<0.05).No significant correlation was found between the FC values linked to the above brain regions and the clinical data.Conclusion:(1)In this experiment,we investigated the structural and functional changes in the brain of PTN patients compared to healthy individuals by using multimodal MRI techniques,and found that the structural and functional changes in several brain regions of the patients,among which the changes in ACC were more significant.It is an important part of PTN-related pathological mechanisms in the central nervous system,and it plays an important role in the perception of nociception and the generation and transmission of negative emotions in PTN patients,as well as an important brain region that guides individuals to perform pain-related behaviors.There is no therapy for ACC in PTN patients,and we believe that ACC may be a potential therapeutic target for PTN.(2)The functional connection between IFG and ACC that plays a role in the pathological mechanism of PTN is not yet clear,and the function played by IFG in pain management needs to be explored by further studies.(3)This experiment used multimodal MRI technology to conduct a comprehensive multidimensional study of PTN,which provided us with a deeper understanding of the pathological mechanism of PTN and a research direction for exploring new therapeutic targets for PTN in the future. |
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