Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Brain Imaging Behav. 2021 Aug;15(4):2061-2068. doi: 10.1007/s11682-020-00400-9. Epub 2020 Oct 8.
Primary dysmenorrhea (PDM) is a cyclic menstrual pain in the absence of pelvic anomalies, and women with PDM have an increased sensitivity to pain than the internal and external areas associated with menstrual pain. However, the brain abnormality in the ascending pain pathways in dysmenorrhea remains largely unclear. As the thalamus plays a significant role in transmission of nociceptive input, we examined whether white matter microstructure of the thalamus-related fiber tracts obtained by DTI in women with PDM (n = 47) differs from healthy controls. A novel tractography atlas-based analysis method that detects tract integrity and altered microstructural properties along selected fibers was employed. The fiber bundles of interest contained the thalamus- primary somatosensory cortex (SI), thalamus- dorsal anterior cingulate cortex (dACC)/supplementary motor area (SMA), thalamus-insula, and thalamus-ACC. As compared with controls, abnormal white matter microstructures were found along the thalamus-related white matter fiber tracts. Additionally, the intensity of menstrual pain was significantly associated with diffusion measures of thalamus-SI fiber connections. Our study suggested that the thalamus-related pain processing pathways had altered white matter integrity that persisted beyond the time of menstruation, and the white matter microstructure of the thalamus-SI pathways was closely related to menstrual pain in the intensity by women with PDM.
原发性痛经（PDM）是指在不存在盆腔异常的情况下周期性的月经疼痛，与月经疼痛相关的内外区域相比，PDM 患者对疼痛的敏感性增加。然而，痛经上行痛觉通路中的大脑异常在很大程度上仍不清楚。由于丘脑在痛觉传入的传递中起着重要作用，我们检查了患有 PDM 的女性（n=47）与健康对照组相比，通过 DTI 获得的丘脑相关纤维束的白质微观结构是否存在差异。采用了一种新的基于轨迹图谱的分析方法，该方法可以检测到沿选定纤维的束完整性和微观结构特性的改变。感兴趣的纤维束包含丘脑-初级体感皮层（SI）、丘脑-背侧前扣带皮层/辅助运动区（dACC/SMA）、丘脑-岛叶和丘脑-ACC。与对照组相比，在丘脑相关的白质纤维束中发现了异常的白质微观结构。此外，月经疼痛的强度与丘脑-SI 纤维连接的扩散测量值显著相关。我们的研究表明，与疼痛处理相关的丘脑通路的白质完整性发生改变，且这种改变持续到月经期之外，并且丘脑-SI 通路的白质微观结构与 PDM 女性的月经疼痛强度密切相关。
