Dziadkowiak Edyta, Koszewicz Magdalena, Podgórski Przemysław, Wieczorek Małgorzata, Budrewicz Sławomir, Zimny Anna
Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland.
Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland.
Front Neurol. 2024 Jan 25;15:1301405. doi: 10.3389/fneur.2024.1301405. eCollection 2024.
The current research aimed to analyze the alterations within the motor cortex and pyramidal pathways and their association with the degree of damage within the peripheral nerve fibers in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). To achieve that goal, we investigated the microstructural changes within the pyramidal white matter tracts using diffusion tensor imaging (DTI) parameters, evaluated metabolic alterations in both precentral gyri using magnetic resonance spectroscopy (MRS) ratios, and correlated them with the neurographic findings in patients with CIDP.
The spectroscopic ratios of NAA/Cr, Cho/Cr, and mI/Cr from both precentral gyri and the values of fractional anisotropy (FA), axial diffusivity (AD), and mean diffusivity (MD) from both of the corticospinal tracts were correlated with the results of neurological and neurographic findings. The comparison of DTI parameters between the patients and controls was performed using Student's -test or the Mann-Whitney test. Due to the lack of normal distribution of most variables, Spearman's Rho rank coefficient was used to test all correlations. All analyses were performed at a significant level of alpha = 0.05 using STATISTICA 13.3.
Compared to the control group (CG), the patient group showed significantly lower ratios of NAA/Cr (1.66 ± 0.11 vs. 1.61 ± 0.15; = 0.022), higher ratios of ml/Cr in the right precentral gyrus (0.57 ± 0.15 vs. 0.61 ± 0.08; = 0.005), and higher levels of Cho/Cr within the left precentral gyrus (0.83 ± 0.09 vs. 0.88 ± 0.14, = 0.012). The DTI parameters of MD from the right CST and AD from the right and left CSTs showed a strong positive correlation (0.52-0.53) with the sural sensory nerve action potential (SNAP) latency of the right sural nerve. There were no other significant correlations between other DTI and MRS parameters and neurographic results.
In our study, significant metabolic alterations were found in the precentral gyri in patients with CIDP without clinical symptoms of central nervous system involvement. The revealed changes reflected neuronal loss or dysfunction, myelin degradation, and increased gliosis. Our results suggest coexisting CNS damage in these patients and may provide a new insight into the still unknown pathomechanism of CIDP.
当前研究旨在分析慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）患者运动皮层和锥体束内的改变及其与周围神经纤维损伤程度的关联。为实现该目标，我们使用扩散张量成像（DTI）参数研究锥体白质束内的微观结构变化，利用磁共振波谱（MRS）比率评估双侧中央前回的代谢改变，并将它们与CIDP患者的神经电生理检查结果相关联。
双侧中央前回的NAA/Cr、Cho/Cr和mI/Cr波谱比率以及双侧皮质脊髓束的分数各向异性（FA）、轴向扩散率（AD）和平均扩散率（MD）值与神经学和神经电生理检查结果相关联。患者组和对照组之间的DTI参数比较采用Student's t检验或Mann-Whitney U检验。由于大多数变量缺乏正态分布，采用Spearman秩相关系数检验所有相关性。所有分析均使用STATISTICA 13.3在显著性水平α = 0.05下进行。
与对照组（CG）相比，患者组的NAA/Cr比率显著降低（1.66 ± 0.11 vs. 1.61 ± 0.15；P = 0.022），右侧中央前回的mI/Cr比率升高（0.57 ± 0.15 vs. 0.61 ± 0.08；P = 0.005），左侧中央前回的Cho/Cr水平升高（0.83 ± 0.09 vs. 0.88 ± 0.14，P = 0.012）。右侧皮质脊髓束的MD以及右侧和左侧皮质脊髓束的AD的DTI参数与右侧腓肠神经的腓肠感觉神经动作电位（SNAP）潜伏期呈强正相关（0.52 - 0.53）。其他DTI和MRS参数与神经电生理检查结果之间无其他显著相关性。
在我们的研究中，未出现中枢神经系统受累临床症状的CIDP患者的中央前回发现了显著的代谢改变。所揭示的变化反映了神经元丢失或功能障碍、髓鞘降解和胶质细胞增生增加。我们的结果提示这些患者存在中枢神经系统损伤并存的情况，并可能为CIDP仍不清楚的发病机制提供新的见解。
