Yacubian Fernandes Adriano, Fernandes da Silva Fabio Eduardo, Hamamoto Filho Pedro Tadao, Talamoni Fonoff Erich
University of São Paulo and São Paulo State University, Brasil.
Rede D'Or, São Paulo, Brasil.
J Clin Neurosci. 2024 Dec;130:110912. doi: 10.1016/j.jocn.2024.110912. Epub 2024 Nov 6.
Diffusion tensor imaging (DTI) has been increasingly utilized in the assessment of spinal cord pathologies for various clinical applications. DTI surpasses conventional MRI in delineating the microstructural integrity of the spinal cord, thereby serving as a potent, non-invasive modality sensitive to white matter pathologies. Postherpetic neuralgia (PHN) is acknowledged to be a consequence not only of peripheral nerve and root lesions but also of central nervous system abnormalities associated with such damage. Our premise posits that the manifestation of PHN may be linked to detectable spinal cord anomalies ascertained through DTI methodologies.
To study the spinal cord of the patients with post herpetic neuralgia (PHN) using DTI techniques, looking at the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) to compare the parameters of the patients that developed PHN with the parameters of the patients that presented herpes zoster (HZ) but didn't present secondary neuralgia. Fifteen patients (two male and thirteen female) were studied. Ten patients presented PHN: nine female and one male; age from 54y to 83y (mean = 72,2). Five patients had HZ without chronic pain: four female and one male with age from 34y to 81y (mean = 60,8).
For ADC, we found higher values among the patients, significant differences in C5, T8, and T9 levels. For FA, we found lower values among the patients, significant differences in T7, T8, and T9 levels. On ROC curves, we identified that D8 was the single level with significant area under the curve (AUC) for discriminating patients with pain. For ADC, the AUC was 0.960 (95 %CI 0.865-1.000), p = 0.005. For FA, the AUC was 0.920 (95 %CI 0.764-1.000), p = 0.010. The cutoff value for pain on ADC was 2455.08, with a sensibility of 90 % and specificity of 100 %. For FA, the cutoff value for not having pain was 395.05, with sensibility of 100 %, and specificity of 90 %.
This investigation highlights the potential for DTI parameters, specifically FA and ADC, to provide insight into the microstructural changes associated with PHN in patients following herpes zoster infection. Future research should continue to explore the implications of these findings in larger cohorts to further elucidate the pathogenesis of neuropathic pain in this population.
扩散张量成像（DTI）在评估脊髓病变以用于各种临床应用方面的应用日益广泛。DTI在描绘脊髓的微观结构完整性方面优于传统MRI，因此是一种对白质病变敏感的强大非侵入性检查方法。带状疱疹后神经痛（PHN）被认为不仅是周围神经和神经根病变的结果，也是与此类损伤相关的中枢神经系统异常的结果。我们的假设是，PHN的表现可能与通过DTI方法确定的可检测到的脊髓异常有关。
使用DTI技术研究带状疱疹后神经痛（PHN）患者的脊髓，观察分数各向异性（FA）和表观扩散系数（ADC），以比较发生PHN的患者与出现带状疱疹（HZ）但未出现继发性神经痛的患者的参数。研究了15例患者（2例男性和13例女性）。10例患者患有PHN：9例女性和1例男性；年龄从54岁至83岁（平均=72.2岁）。5例患者患有HZ但无慢性疼痛：4例女性和1例男性，年龄从34岁至81岁（平均=60.8岁）。
对于ADC，我们发现患者中该值较高，在C5、T8和T9水平存在显著差异。对于FA，我们发现患者中该值较低，在T7、T8和T9水平存在显著差异。在ROC曲线上，我们确定D8是区分疼痛患者的曲线下面积（AUC）有显著意义的单一水平。对于ADC，AUC为0.960（95%CI 0.865 - 1.000），p = 0.005。对于FA，AUC为0.920（95%CI 0.764 - 1.000），p = 0.010。ADC上疼痛的截断值为2455.08，敏感性为90%，特异性为100%。对于FA，无疼痛的截断值为395.05，敏感性为100%，特异性为90%。
本研究强调了DTI参数，特别是FA和ADC，在洞察带状疱疹感染后患者中与PHN相关的微观结构变化方面的潜力。未来的研究应继续在更大的队列中探索这些发现的意义，以进一步阐明该人群中神经性疼痛的发病机制。
