Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
J Neurol Neurosurg Psychiatry. 2019 Mar;90(3):326-332. doi: 10.1136/jnnp-2018-318886. Epub 2018 Dec 15.
Post-traumatic headache (PTH) is one of the most frequent and persistent physical symptoms following mild traumatic brain injury (mTBI) and develop in more than 50% of this population. This study aimed to investigate the periaqueductal grey (PAG)-seeded functional connectivity (FC) in patients with mTBI with acute post-traumatic headache (APTH) and further examine whether the FC can be used as a neural biomarker to identify patients developing chronic pain 3 months postinjury.
70 patients with mTBI underwent neuropsychological measurements and MRI scans within 7 days postinjury and 56 (80%) of patients were followed up at 3 months. 46 healthy controls completed the same protocol on recruitment to the study. PAG-seeded resting-state FC analysis was measured in 54 patients with mTBI with APTH, in comparison with 46 healthy volunteers.
The mTBI+APTH group presented significantly reduced PAG-seeded FC within the default mode network (DMN), compared with healthy volunteers group. The connectivity strength can also predict patients' complaints on the impact of headache on their lives. Crucially, the initial FC strength between the PAG-right precuneus as well as the PAG-right inferior parietal lobule became the important predictor to identify patients with mTBI developing persistent PTH 3 months postinjury.
Patients with mTBI+APTH exhibited significant PAG-related FC differences mainly within the DMN. These regions extended beyond traditional pain processing areas and may reflect the diminished top-down attention regulation of pain perception through antinociceptive descending modulation network. The disrupted PAG-DMN FC may be used as an early imaging biomarker to identify patients at risk of developing persistent PTH.
创伤后头痛（PTH）是轻度创伤性脑损伤（mTBI）后最常见和持续的身体症状之一，超过 50%的此类人群会出现这种情况。本研究旨在调查急性创伤后头痛（APTH）的 mTBI 患者的中脑导水管周围灰质（PAG）种子的功能连接（FC），并进一步研究该 FC 是否可作为神经生物标志物，以识别出在损伤后 3 个月发生慢性疼痛的患者。
70 名 mTBI 患者在损伤后 7 天内接受神经心理学测量和 MRI 扫描，其中 56 名（80%）患者在 3 个月时进行了随访。46 名健康对照者在入组研究时完成了相同的方案。在 54 名患有 mTBI 和 APTH 的患者中进行了 PAG 种子的静息状态 FC 分析，与 46 名健康志愿者进行了比较。
与健康志愿者组相比，mTBI+APTH 组 PAG 种子的默认模式网络（DMN）内的 FC 显著降低。连接强度也可以预测患者对头痛对生活影响的抱怨。至关重要的是，PAG-右侧楔前叶和 PAG-右侧顶下小叶之间的初始 FC 强度成为识别 mTBI 患者在损伤后 3 个月发生持续性 PTH 的重要预测指标。
患有 mTBI+APTH 的患者表现出明显的与 PAG 相关的 FC 差异，主要位于 DMN 内。这些区域超出了传统的疼痛处理区域，可能反映了通过抗伤害性下行调节网络对疼痛感知的自上而下的注意力调节能力下降。受损的 PAG-DMN FC 可作为识别发生持续性 PTH 风险患者的早期影像学生物标志物。
