Lyu Haiying, Zhu Xue, He Naying, Li Qing, Yin Qianyi, Huang Yufei, Yan Fuhua, Liu Jun, Lu Yong
Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Magn Reson Imaging. 2023 Nov;58(5):1472-1487. doi: 10.1002/jmri.28693. Epub 2023 Mar 29.
The central autonomic network (CAN) plays a critical role in the body's sympathetic and parasympathetic control. However, functional connectivity (FC) changes of the CAN in patients with multiple system atrophy (MSA) remain unknown.
To investigate FC alterations of CAN in MSA patients.
Prospective.
Eighty-two subjects (47 patients with MSA [44.7% female, 60.5 ± 6.9 years], 35 age- and sex-matched healthy controls [HC] [57.1% female, 62.5 ± 6.6 years]).
FIELD STRENGTH/SEQUENCE: 3-T, resting-state functional magnetic resonance imaging (rs-fMRI) using gradient echo-planar imaging (EPI), T1-weighted three-dimensional magnetization-prepared rapid gradient echo (3D MPRAGE) structural MRI.
FC alterations were explored by using core modulatory regions of CAN as seeds, including midcingulate cortex, insula, amygdala, and ventromedial prefrontal cortex. Bartlett factor score (BFS) derived from a factor analysis of clinical assessments on disease severity was used as a grouping factor for moderate MSA (mMSA: BFS < 0) and severe MSA (sMSA: BFS > 0).
For FC analysis, the one-way ANCOVA with cluster-level family-wise error correction (statistical significance level of P < 0.025), and post hoc t-testing with Bonferroni correction or Tamhane's T2 correction (statistical significance level of adjusted-P < 0.05) were adopted. Correlation was assessed using Pearson correlation or Spearman correlation (statistical significance level of P < 0.05).
Compared with HC, patients with MSA exhibited significant FC aberrances between the CAN and brain areas of sensorimotor control, limbic network, putamen, and cerebellum. For MSA patients, most FC alterations of CAN, especially concerning FC between the right anterior insula and right primary sensorimotor cortices, were found to be significantly correlated with disease severity. FC changes were found to be more significant in sMSA group than in mMSA group when compared with HCs.
MSA shows widespread FC changes of CAN, suggesting that abnormal functional integration of CAN may be involved in disease pathogenesis of MSA.
2 TECHNICAL EFFICACY: Stage 3.
中枢自主神经网络（CAN）在机体交感神经和副交感神经控制中起关键作用。然而，多系统萎缩（MSA）患者中CAN的功能连接（FC）变化尚不清楚。
研究MSA患者中CAN的FC改变。
前瞻性研究。
82名受试者（47例MSA患者[女性占44.7%，年龄60.5±6.9岁]，35名年龄和性别匹配的健康对照者[HC][女性占57.1%，年龄62.5±6.6岁]）。
场强/序列：3-T，使用梯度回波平面成像（EPI）的静息态功能磁共振成像（rs-fMRI），T1加权三维磁化准备快速梯度回波（3D MPRAGE）结构MRI。
以CAN的核心调节区域作为种子点来探究FC改变，这些区域包括扣带回中部皮质、岛叶、杏仁核和腹内侧前额叶皮质。源自疾病严重程度临床评估因子分析的巴特利特因子评分（BFS）用作中度MSA（mMSA：BFS＜0）和重度MSA（sMSA：BFS＞0）的分组因子。
对于FC分析，采用带有簇水平家族性错误校正的单因素协方差分析（统计显著性水平P＜0.025），以及采用Bonferroni校正或Tamhane's T2校正的事后t检验（校正后P值的统计显著性水平＜0.05）。使用Pearson相关或Spearman相关评估相关性（统计显著性水平P＜0.05）。
与HC相比，MSA患者在CAN与感觉运动控制脑区、边缘网络、壳核和小脑之间表现出显著的FC异常。对于MSA患者，发现CAN的大多数FC改变，尤其是右前岛叶与右初级感觉运动皮质之间的FC，与疾病严重程度显著相关。与HC相比，sMSA组的FC变化比mMSA组更显著。
MSA显示出CAN广泛的FC变化，表明CAN的异常功能整合可能参与MSA的疾病发病机制。
2 技术效能：3级
