The Application And Efficacy Of Functional Magnetic Resonance Imaging Combined With Transcranial Magnetic Stimulation To Guaid Individually Precise Localization In The Treatment Of Chronic Tinnitus

Purpose: The aim of this study was to investigate the safety and efficacy of continuous theta-burst stimulation(c TBS)in the treatment of tinnitus,and to explore the pathogenesis of tinnitus by using functional magnetic resonance imaging(f MRI).Methods: A total of 16 chronic subjective tinnitus patients were included in this study.Prior to treatment,all patients were performed audiological examinations,tinnitus matching,f MRI scan,resting motor threshold(RMT)measurement and related questionnaires.Our experiment calculates the coordinates of personalized superior temporal gyrus(STG)target based on task-f MRI,and uses navigation tracking for precise localization.The stimulation intensity for the c TBS was set at80%RMT,with a duration of 80 seconds.The treatment was administered twice a day with a 15-minute interval for 10 consecutive days,totaling 2400 pulses.After that,measurements in these patients were obtained in the end of treatment,along with 1month and 3 month follow-up.The differences of the scales,regional homogeneity(Re Ho),amplitude of low-frequency fluctuation(ALFF),fractional ALFF(f ALFF)and functional connectivity(FC)were analyzed.Results: Transcranial magnetic stimulation(TMS)is effective and safe for chronic tinnitus patients.Compared with baseline,VAS(p=0.004)scale value was significantly improved after treatment and follow-up.Patients had major greater z ALFF values in several brain regions including the left middle temporal gyrus(MTG,p<0.005,t=5.297)and left STG(p<0.005,t=5.238)compared to baseline.There were tremendous differences in zf ALFF values before and after treatment,such as left STG(p<0.005,t=5.975),and left superior parietal gyrus(SPG,p<0.005,t=-5.234).Furthermore,the values of sm Re Ho in left STG(p <0.005,t=6.064),left MTG(p<0.005,t=5.196),and right STG(p<0.005,t=4.234)were importantly enhanced after treatment.Taking the both STG as the seeds to make FC with the whole brain,the results showed that after treatment,the right STG(58,-21,47)had reduced z FC values with right cerebellum(p<0.005,t=-8.530),right inferior occipital gyrus(IOG,p<0.005,t=-4.940),right superior frontal gyrus(SFG,p<0.005,t=-5.027)in tinnitus patients.Additionally,the left STG(-65,-11,4)showed enhanced z FC values with left middle occipital gyrus(MOG,p<0.005,t=5.182),left middle frontal gyrus(MFG,p<0.005,t=4.348),and right middle cingulum gyrus(MCG,p<0.005,t=5.048).Conclusions: The combination of f MRI and TMS therapy for tinnitus is effective and safe.f MRI can provide accurate targets for TMS while TMS has a regulatory effect on the neuronal activity in deep brain regions.