DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Philadelphia, Pennsylvania.
Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia.
JAMA. 2019 Jul 23;322(4):336-347. doi: 10.1001/jama.2019.9269.
United States government personnel experienced potential exposures to uncharacterized directional phenomena while serving in Havana, Cuba, from late 2016 through May 2018. The underlying neuroanatomical findings have not been described.
To examine potential differences in brain tissue volume, microstructure, and functional connectivity in government personnel compared with individuals not exposed to directional phenomena.
DESIGN, SETTING, AND PARTICIPANTS: Forty government personnel (patients) who were potentially exposed and experienced neurological symptoms underwent evaluation at a US academic medical center from August 21, 2017, to June 8, 2018, including advanced structural and functional magnetic resonance imaging analytics. Findings were compared with imaging findings of 48 demographically similar healthy controls.
Potential exposure to uncharacterized directional phenomena of unknown etiology, manifesting as pressure, vibration, or sound.
Potential imaging-based differences between patients and controls with regard to (1) white matter and gray matter total and regional brain volumes, (2) cerebellar tissue microstructure metrics (eg, mean diffusivity), and (3) functional connectivity in the visuospatial, auditory, and executive control subnetworks.
Imaging studies were completed for 40 patients (mean age, 40.4 years; 23 [57.5%] men; imaging performed a median of 188 [range, 4-403] days after initial exposure) and 48 controls (mean age, 37.6 years; 33 [68.8%] men). Mean whole brain white matter volume was significantly smaller in patients compared with controls (patients: 542.22 cm3; controls: 569.61 cm3; difference, -27.39 [95% CI, -37.93 to -16.84] cm3; P < .001), with no significant difference in the whole brain gray matter volume (patients: 698.55 cm3; controls: 691.83 cm3; difference, 6.72 [95% CI, -4.83 to 18.27] cm3; P = .25). Among patients compared with controls, there were significantly greater ventral diencephalon and cerebellar gray matter volumes and significantly smaller frontal, occipital, and parietal lobe white matter volumes; significantly lower mean diffusivity in the inferior vermis of the cerebellum (patients: 7.71 × 10-4 mm2/s; controls: 8.98 × 10-4 mm2/s; difference, -1.27 × 10-4 [95% CI, -1.93 × 10-4 to -6.17 × 10-5] mm2/s; P < .001); and significantly lower mean functional connectivity in the auditory subnetwork (patients: 0.45; controls: 0.61; difference, -0.16 [95% CI, -0.26 to -0.05]; P = .003) and visuospatial subnetwork (patients: 0.30; controls: 0.40; difference, -0.10 [95% CI, -0.16 to -0.04]; P = .002) but not in the executive control subnetwork (patients: 0.24; controls: 0.25; difference: -0.016 [95% CI, -0.04 to 0.01]; P = .23).
Among US government personnel in Havana, Cuba, with potential exposure to directional phenomena, compared with healthy controls, advanced brain magnetic resonance imaging revealed significant differences in whole brain white matter volume, regional gray and white matter volumes, cerebellar tissue microstructural integrity, and functional connectivity in the auditory and visuospatial subnetworks but not in the executive control subnetwork. The clinical importance of these differences is uncertain and may require further study.
自 2016 年末至 2018 年 5 月，美国政府人员在古巴哈瓦那服役期间可能接触到未被描述的定向现象。尚未描述潜在的神经解剖学发现。
比较潜在暴露于定向现象的政府人员与未暴露于定向现象的个体之间的脑组织体积、微观结构和功能连接的潜在差异。
设计、地点和参与者：2017 年 8 月 21 日至 2018 年 6 月 8 日，在美国学术医疗中心对 40 名可能暴露于定向现象并经历神经症状的政府人员（患者）进行了评估，包括先进的结构和功能磁共振成像分析。结果与 48 名在人口统计学上相似的健康对照进行了比较。
潜在暴露于未知病因的未被描述的定向现象，表现为压力、振动或声音。
患者与对照组之间潜在的基于成像的差异，包括（1）全脑和局部脑白质和灰质总容量，（2）小脑组织微观结构指标（如平均弥散度），以及（3）视觉空间、听觉和执行控制子网的功能连接。
对 40 名患者（平均年龄，40.4 岁；23 名[57.5%]男性；中位暴露后时间为 188 [范围，4-403] 天）和 48 名对照（平均年龄，37.6 岁；33 名[68.8%]男性）完成了成像研究。与对照组相比，患者的全脑白质体积明显较小（患者：542.22 cm3；对照组：569.61 cm3；差异，-27.39 [95% CI，-37.93 至-16.84] cm3；P < 0.001），但全脑灰质体积无显著差异（患者：698.55 cm3；对照组：691.83 cm3；差异，6.72 [95% CI，-4.83 至 18.27] cm3；P = 0.25）。与对照组相比，患者的腹侧间脑和小脑灰质体积较大，而额叶、枕叶和顶叶白质体积较小；小脑下蚓部的平均弥散度较低（患者：7.71×10-4 mm2/s；对照组：8.98×10-4 mm2/s；差异，-1.27×10-4 [95% CI，-1.93×10-4 至-6.17×10-5] mm2/s；P < 0.001）；听觉子网（患者：0.45；对照组：0.61；差异，-0.16 [95% CI，-0.26 至-0.05]；P = 0.003）和视觉空间子网（患者：0.30；对照组：0.40；差异，-0.10 [95% CI，-0.16 至-0.04]；P = 0.002）的平均功能连接较低，但执行控制子网（患者：0.24；对照组：0.25；差异：-0.016 [95% CI，-0.04 至 0.01]；P = 0.23）无显著差异。
在古巴哈瓦那可能接触定向现象的美国政府人员中，与健康对照组相比，先进的脑磁共振成像显示全脑白质体积、局部灰质和白质体积、小脑组织微观结构完整性以及听觉和视觉空间子网的功能连接存在显著差异，但执行控制子网无显著差异。这些差异的临床意义尚不确定，可能需要进一步研究。
