Weisstanner Christian, Mordasini Livio, Thalmann George N, Verma Rajeev K, Rummel Christian, Federspiel Andrea, Kessler Thomas M, Wiest Roland
Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Switzerland.
Department of Urology, Cantonal Hospital Lucerne, Switzerland.
Swiss Med Wkly. 2017 Aug 2;147:w14454. doi: 10.4414/smw.2017.14454. eCollection 2017.
The imaging method most frequently employed to identify brain areas involved in neuronal processing of nociception and brain pain perception is blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI). Arterial spin labelling (ASL), in contrast, offers advantages when slow varying changes in brain function are investigated. Chronic pelvic pain syndrome (CPPS) is a disorder of, mostly, young males that leads to altered pain perceptions in structures related to the pelvis. We aimed to investigate the potential of ASL to monitor longitudinal cranial blood flow (CBF) changes in patients with CPPS.
In a randomised, placebo-controlled, double-blind single centre trial, we investigated treatment effects in CPPS after 12 weeks in patients that underwent sono-electro-magnetic therapy vs placebo. We investigated changes of CBF related to treatment outcome using pseudo-continuous arterial spin labelling (pCASL)-MRI.
We observed CBF downregulation in the prefrontal cortex and anterior cingulate cortex and upregulation in the dorsolateral prefrontal cortex in responders. Nonresponders presented with CBF upregulation in the hippocampus. In patients with a history of CPPS of less than 12 months, there were significant correlations between longitudinal CBF changes and the Chronic Prostatitis Symptom Index pain subscore within the joint clusters anterior cingulate cortex and left anterior prefrontal cortex in responders, and the right hippocampus in nonresponders.
We demonstrated therapy-related and stimulus-free longitudinal CBF changes in core areas of the pain matrix using ASL. ASL may act as a complementary noninvasive method to functional MRI and single-photon emission computed tomography / positron emission tomography, especially in the longitudinal assessment of pain response in clinical trials.
用于识别参与伤害性感受神经元处理和脑痛觉感知的脑区的最常用成像方法是血氧水平依赖（BOLD）磁共振成像（MRI）。相比之下，当研究脑功能的缓慢变化时，动脉自旋标记（ASL）具有优势。慢性盆腔疼痛综合征（CPPS）主要是一种年轻男性的疾病，会导致与骨盆相关结构的痛觉改变。我们旨在研究ASL监测CPPS患者纵向颅血流量（CBF）变化的潜力。
在一项随机、安慰剂对照、双盲单中心试验中，我们研究了接受超声电磁疗法与安慰剂治疗的CPPS患者12周后的治疗效果。我们使用伪连续动脉自旋标记（pCASL）-MRI研究了与治疗结果相关的CBF变化。
我们观察到反应者前额叶皮质和前扣带回皮质的CBF下调，背外侧前额叶皮质的CBF上调。无反应者海马体的CBF上调。在CPPS病史小于12个月的患者中，反应者前扣带回皮质和左前额叶皮质联合簇内以及无反应者右海马体的纵向CBF变化与慢性前列腺炎症状指数疼痛子评分之间存在显著相关性。
我们使用ASL证明了疼痛矩阵核心区域与治疗相关且无需刺激的纵向CBF变化。ASL可能作为功能MRI和单光子发射计算机断层扫描/正电子发射断层扫描的一种补充性非侵入性方法，尤其是在临床试验中对疼痛反应的纵向评估中。
