From the Departments of Radiology (E.B.A., I.H.P.-M., J.M., B.v.L., M.A.v.B., M.C.K.) and Neurology (H.K.) and Laboratory for Clinical and Experimental Image Processing, Department of Radiology (J.M., B.v.L.), Leiden University Medical Center; Department of Neurology (H.K., G.M.T., M.D.F.), Haga Hospital, The Hague, the Netherlands; Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD; and Department of Radiology (P.A.M.H.), Maastricht University Medical Center, the Netherlands.
Neurology. 2019 Aug 13;93(7):e688-e694. doi: 10.1212/WNL.0000000000007940. Epub 2019 Jul 11.
We used magnetization transfer imaging to assess white matter tissue integrity in migraine, to explore whether white matter microstructure was more diffusely affected beyond visible white matter hyperintensities (WMHs), and to explore whether focal invisible microstructural changes precede visible focal WMHs in migraineurs.
We included 137 migraineurs (79 with aura, 58 without aura) and 74 controls from the Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis (CAMERA) study, a longitudinal population-based study on structural brain lesions in migraine patients, who were scanned at baseline and at a 9-year follow-up. To assess microstructural brain tissue integrity, baseline magnetization transfer ratio (MTR) values were calculated for whole brain white matter. Baseline MTR values were determined for areas of normal-appearing white matter (NAWM) that had progressed into MRI-detectable WMHs at follow-up and compared to MTR values of contralateral NAWM.
MTR values for whole brain white matter did not differ between migraineurs and controls. In migraineurs, but not in controls, NAWM that later progressed to WMHs at follow-up had lower mean MTR (mean [SD] 0.354 [0.009] vs 0.356 [0.008], = 0.047) at baseline as compared to contralateral white matter.
We did not find evidence for widespread microstructural white matter changes in migraineurs compared to controls. However, our findings suggest that a gradual or stepwise process might be responsible for evolution of focal invisible microstructural changes into focal migraine-related visible WMHs.
我们采用磁化传递成像来评估偏头痛患者的白质组织完整性，以探究白质微观结构是否除了可见的白质高信号（WMH）之外还存在更广泛的影响，并探讨偏头痛患者是否存在局灶性不可见微观结构变化先于可见局灶性 WMH。
我们纳入了来自偏头痛大脑异常、流行病学风险分析（CAMERA）研究的 137 名偏头痛患者（79 名伴先兆，58 名不伴先兆）和 74 名对照，这是一项关于偏头痛患者结构性脑损伤的纵向基于人群的研究，这些患者在基线和 9 年随访时进行了扫描。为了评估微观结构脑组织完整性，我们计算了全脑白质的磁化传递率（MTR）值。我们确定了在随访时进展为 MRI 可检测到的 WMH 的正常外观白质（NAWM）区域的基线 MTR 值，并将其与对侧 NAWM 的 MTR 值进行了比较。
偏头痛患者和对照组的全脑白质 MTR 值没有差异。在偏头痛患者中，但不在对照组中，随后在随访时进展为 WMH 的 NAWM 的平均 MTR（平均值[标准差]0.354[0.009]与 0.356[0.008]，=0.047）在基线时低于对侧白质。
与对照组相比，我们没有发现偏头痛患者存在广泛的微观结构白质变化的证据。然而，我们的发现表明，渐进或阶段性过程可能是导致局灶性不可见微观结构变化演变为局灶性与偏头痛相关的可见 WMH 的原因。
