Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA.
Department of Medicine, University of California Los Angeles, Los Angeles, CA.
J Neuroimaging. 2021 May;31(3):524-531. doi: 10.1111/jon.12840. Epub 2021 Feb 9.
Patients with pulmonary arterial hypertension (PAH) frequently present with anxiety, depression, autonomic, and cognitive deterioration, which may indicate brain changes in regions that control these functions. However, the precise regional brain-injury in sites that regulate cognitive, autonomic, and mood functions in PAH remains unclear. We examined the shifts in regional gray matter (GM) volume, using high-resolution T1-weighted images, and brain tissue alterations, using T2-relaxometry procedures, in PAH compared to healthy subjects.
We collected two high-resolution T1-weighted series, and proton-density and T2-weighted images using a 3.0-Tesla magnetic resonance imaging scanner from 9 PAH and 19 healthy subjects. Both high-resolution T1-weighted images were realigned and averaged, partitioned to GM tissue type, normalized to a common space, and smoothed. Using proton-density and T2-weighted images, T2-relaxation maps were calculated, normalized to a common space, and smoothed. Whole-brain GM volume and T2-relaxation maps were compared between PAH and controls using analysis of covariance (covariates, age, sex, and total-brain-volume; false discover rate corrections).
Significantly decreased GM volumes, indicating tissue injury, emerged in multiple brain regions, including the hippocampus, insula, cerebellum, parahippocampus, temporal, frontal, and occipital gyri, cingulate, amygdala, and thalamus. Higher T2-relaxation values, suggesting tissue damage, appeared in the cerebellum, hippocampus, parahippocampus, frontal, lingual, and temporal and occipital gyri, and cingulate areas in PAH compared to healthy subjects.
PAH patients showed significant GM injury and brain tissue changes in sites that regulate cognition, autonomic, and mood functions. These findings indicate a brain structural basis for functional deficits in PAH patients.
肺动脉高压（PAH）患者常伴有焦虑、抑郁、自主神经和认知功能恶化，这可能表明控制这些功能的大脑区域发生了变化。然而，PAH 患者调节认知、自主神经和情绪功能的特定脑损伤部位尚不清楚。我们使用高分辨率 T1 加权图像检查了 PAH 患者与健康受试者相比，脑区灰质（GM）体积的变化，并使用 T2 弛豫度检查了脑组织结构的变化。
我们使用 3.0 特斯拉磁共振成像扫描仪收集了 9 例 PAH 患者和 19 例健康受试者的两组高分辨率 T1 加权序列以及质子密度和 T2 加权图像。对两组高分辨率 T1 加权图像进行重新配准和平均化，分为 GM 组织类型，归一化到共同空间，并进行平滑处理。使用质子密度和 T2 加权图像，计算 T2 弛豫图，归一化到共同空间，并进行平滑处理。使用协方差分析（协变量为年龄、性别和全脑容积；假发现率校正）比较 PAH 患者和对照组之间的全脑 GM 体积和 T2 弛豫图。
在多个脑区，包括海马体、脑岛、小脑、旁海马体、颞叶、额叶和枕叶回、扣带回、杏仁核和丘脑，出现了 GM 体积明显减少，表明存在组织损伤。在 PAH 患者中，与健康受试者相比，小脑、海马体、旁海马体、额叶、舌回和颞叶及枕叶回、扣带回区的 T2 弛豫值升高，表明存在组织损伤。
PAH 患者出现了与认知、自主神经和情绪功能调节相关的 GM 损伤和脑组织变化。这些发现表明 PAH 患者存在功能缺陷的脑结构基础。
