Department of Neurology, Atatürk Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, Atatürk Eğitim ve Araştırma Hastanesi, Nöroloji Kliniği, Basın Sitesi, İzmir, Turkey,
Clin Neuroradiol. 2013 Dec;23(4):277-83. doi: 10.1007/s00062-013-0203-4. Epub 2013 Feb 9.
Novel diagnostics can allow us to "look beyond" normal-appearing brain tissue (NABT) to unravel subtle alterations pertinent to the pathophysiology of primary headache, one of the most common complaints of patients who present to their physician across the medical specialties. Using both magnetization transfer imaging (MTI) and diffusion weighted imaging (DWI), we assessed the putative microstructural changes in patients with primary headache who display the NABT on conventional magnetic resonance imaging (conventional MRI).
Subjects were 53 consecutive patients with primary headache disorders (40 = migraine with aura; 9 = tension headache; 4 = cluster headache) and 20 sex- and age-matched healthy volunteers. All subjects underwent evaluation with MRI, MTI, and DWI in order to measure the magnetization transfer ratio (MTR) and the apparent diffusion coefficient (ADC), respectively, in eight and six different regions of interest (ROIs).
Compared to healthy controls, we found a significant 4.3 % increase in the average ADC value of the occipital white matter in the full sample of patients (p = 0.035) and in patients with migraine (p = 0.046). MTR values did not differ significantly in ROIs between patients and healthy controls (p > 0.05).
The present study lends evidence, for the first time to the best of our knowledge, for a statistically significant microstructural change in the occipital lobes, as measured by ADC, in patients with primary headache who exhibit a NABT on MRI. Importantly, future longitudinal mechanistic clinical studies of primary headache (e.g., vis-à-vis neuroimaging biomarkers) would be well served by characterizing, via DWI, occipital white matter microstructural changes to decipher their broader biological significance.
新的诊断方法可以让我们“超越”看似正常的脑组织（NABT），揭示与原发性头痛病理生理学相关的细微改变，原发性头痛是患者向跨医学专业的医生就诊时最常见的抱怨之一。使用磁化传递成像（MTI）和弥散加权成像（DWI），我们评估了在常规磁共振成像（常规 MRI）上显示 NABT 的原发性头痛患者的潜在微观结构变化。
研究对象为 53 例连续原发性头痛障碍患者（40 例=有先兆偏头痛；9 例=紧张性头痛；4 例=丛集性头痛）和 20 名性别和年龄匹配的健康志愿者。所有受试者均接受 MRI、MTI 和 DWI 评估，以分别测量 8 个和 6 个不同感兴趣区（ROI）的磁化转移比（MTR）和表观扩散系数（ADC）。
与健康对照组相比，我们发现患者全样本（p=0.035）和偏头痛患者（p=0.046）枕叶白质的平均 ADC 值显著增加了 4.3%。患者与健康对照组 ROI 之间的 MTR 值无显著差异（p>0.05）。
本研究首次提供证据表明，在 MRI 上显示 NABT 的原发性头痛患者的枕叶存在结构上的统计学显著微观变化，通过 ADC 测量。重要的是，未来原发性头痛的纵向机制临床研究（例如，与神经影像学生物标志物相对照）将通过 DWI 来描述枕叶白质微观结构变化，以破译其更广泛的生物学意义。
