Tanabe Jody, Regner Michael, Sakai Joseph, Martinez Diana, Gowin Joshua
1Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, CO.
2Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO.
Br J Radiol. 2019 Sep;92(1101):20180942. doi: 10.1259/bjr.20180942. Epub 2019 May 14.
Substance use disorder is a leading causes of preventable disease and mortality. Drugs of abuse cause molecular and cellular changes in specific brain regions and these neuroplastic changes are thought to play a role in the transition to uncontrolled drug use. Neuroimaging has identified neural substrates associated with problematic substance use and may offer clues to reduce its burden on the patient and society. Here, we provide a narrative review of neuroimaging studies that have examined the structures and circuits associated with reward, cues and craving, learning, and cognitive control in substance use disorders. Most studies use advanced MRI or positron emission tomography (PET). Many studies have focused on the dopamine neurons of the ventral tegmental area, and the regions where these neurons terminate, such as the striatum and prefrontal cortex. Decreases in dopamine receptors and transmission have been found in chronic users of drugs, alcohol, and nicotine. Recent studies also show evidence of differences in structure and function in substance users relative to controls in brain regions involved in salience evaluation, such as the insula and anterior cingulate cortex. Balancing between reward-related bottom-up and cognitive-control-related top-down processes is discussed in the context of neuromodulation as a potential treatment. Finally, some of the challenges for understanding substance use disorder using neuroimaging methods are discussed.
物质使用障碍是可预防疾病和死亡的主要原因。滥用药物会导致特定脑区发生分子和细胞变化，这些神经可塑性变化被认为在向不受控制的药物使用转变过程中发挥作用。神经影像学已确定了与问题性物质使用相关的神经基质，并可能为减轻其对患者和社会的负担提供线索。在此，我们对神经影像学研究进行了叙述性综述，这些研究探讨了物质使用障碍中与奖赏、线索与渴望、学习及认知控制相关的结构和回路。大多数研究使用先进的磁共振成像（MRI）或正电子发射断层扫描（PET）。许多研究聚焦于腹侧被盖区的多巴胺能神经元及其终末区域，如纹状体和前额叶皮质。在药物、酒精和尼古丁的长期使用者中发现了多巴胺受体及传递的减少。近期研究还显示，在涉及显著性评估的脑区，如脑岛和前扣带回皮质，物质使用者相对于对照组在结构和功能上存在差异。在神经调节作为一种潜在治疗方法的背景下，讨论了奖赏相关的自下而上过程和认知控制相关的自上而下过程之间的平衡。最后，讨论了使用神经影像学方法理解物质使用障碍所面临的一些挑战。
