Petrou M, Harris R E, Foerster B R, McLean S A, Sen A, Clauw D J, Sundgren P C
Department of Radiology, Division of Neuroradiology, University of Michigan Hospitals, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-0030, USA.
AJNR Am J Neuroradiol. 2008 May;29(5):913-8. doi: 10.3174/ajnr.A0959. Epub 2008 Mar 13.
Widespread pain sensitivity in patients with fibromyalgia (FM) suggests a central nervous system (CNS)-processing problem. Therefore, it is conceivable that metabolic alterations exist in pain-processing brain regions of people with FM compared with healthy controls (HC) and that such metabolic data could correlate with clinical symptoms. The purpose of this study was to test these hypotheses using proton MR spectroscopy ((1)H-MR spectroscopy).
There were 21 patients with FM and 27 HC who underwent conventional structural MR imaging and additional 2D-chemical shift imaging (CSI) MR-spectroscopy sequences. For the 2D-CSI spectroscopy, larger volumes of interest (VOIs) were centered at the level of the basal ganglia and the supraventricular white matter. Within these larger areas, 16 smaller voxels were placed in a number of regions previously implicated in pain processing. N-acetylaspartate (NAA)/creatine(Cr), choline (Cho)/Cr and NAA/Cho ratios were calculated for each voxel. Subjects underwent clinical and experimental pain assessment.
Mean metabolite ratios and ratio variability for each region were analyzed by using repeated-measures analysis of variance (ANOVA). Correlations between clinical symptoms and metabolite ratios were assessed. Cho/Cr variability in the right dorsolateral prefrontal cortex (DLPFC) was significantly different in the 2 groups; a significant correlation between Cho/Cr in this location and clinical pain was present in the FM group. Evoked pain threshold correlated significantly with NAA/Cho ratios in the left insula and left basal ganglia.
Our data suggest that there are baseline differences in the variability of brain metabolite relative concentrations between patients with FM and HC, especially in the right DLPFC. Furthermore, there are significant correlations between metabolite ratios and clinical and experimental pain parameters in patients with FM.
纤维肌痛（FM）患者广泛的疼痛敏感性提示存在中枢神经系统（CNS）处理问题。因此，可以想象，与健康对照（HC）相比，FM患者疼痛处理脑区存在代谢改变，且这种代谢数据可能与临床症状相关。本研究的目的是使用质子磁共振波谱（（1）H-MR波谱）来验证这些假设。
21例FM患者和27例HC接受了常规结构磁共振成像以及额外的二维化学位移成像（CSI）磁共振波谱序列检查。对于二维CSI波谱，较大的感兴趣区（VOIs）以基底节和室上白质水平为中心。在这些较大区域内，在先前涉及疼痛处理的多个区域放置了16个较小的体素。计算每个体素的N-乙酰天门冬氨酸（NAA）/肌酸（Cr）、胆碱（Cho）/Cr和NAA/Cho比值。受试者接受临床和实验性疼痛评估。
采用重复测量方差分析（ANOVA）分析每个区域的平均代谢物比值和比值变异性。评估临床症状与代谢物比值之间的相关性。两组右侧背外侧前额叶皮质（DLPFC）的Cho/Cr变异性有显著差异；FM组该部位的Cho/Cr与临床疼痛之间存在显著相关性。诱发性疼痛阈值与左侧脑岛和左侧基底节的NAA/Cho比值显著相关。
我们的数据表明，FM患者与HC之间脑代谢物相对浓度变异性存在基线差异，尤其是在右侧DLPFC。此外，FM患者的代谢物比值与临床和实验性疼痛参数之间存在显著相关性。
