Peng Kun, Zhang Ning, Liu Qing, Xiao Ailian, Wang Kaiyu, Zhang Hui
College of Medical Imaging, Shanxi Medical University, Taiyuan, China.
Department of Radiology, The Sixth Hospital of Shanxi Medical University (General Hospital of TISCO), Taiyuan, China.
Quant Imaging Med Surg. 2025 May 1;15(5):3911-3922. doi: 10.21037/qims-24-1830. Epub 2025 Apr 14.
Obstructive sleep apnea (OSA) is a relatively common sleep disorder, which can damage the brain structure and thus trigger cognitive impairment. We aimed to assess changes in volume and relaxation values of subcortical gray matter nuclei in patients with moderate to severe OSA using synthetic magnetic resonance imaging (SyMRI).
A total of 30 patients with moderate to severe OSA, newly diagnosed by polysomnography (PSG), and 30 age-, sex-, education-, and handedness-matched healthy controls (HC) were recruited. All participants underwent the Montreal Cognitive Assessment (MoCA) Scale. Conventional MRI, three-dimensional T1-weighted brain volume (3D T1-BRAVO), and SyMRI were performed on both groups using a 3.0TMR scanner. After scanning, original SyMRI data were post-processed using SyMRI8.0 software to automatically generate T1, T2, and proton density (PD) quantitative maps, and subcortical gray matter nuclei were obtained using SPM12 software (Matlab R2015b). Cognitive scale scores, subcortical gray matter nuclei volume, and relaxation quantitative values were compared between groups. Volume and relaxation quantitative values were corrected for multiple comparisons using a false discovery rate (FDR). SyMRI quantitative parameters with statistically significant differences underwent receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC). Correlations between changes in abnormal brain volume and relaxation values and MoCA scores were analyzed in the OSA group, using FDR for multiple comparisons and corrections.
Compared to controls, the OSA group exhibited a significant decrease in bilateral thalamic volume (P=0.002, 0.003, uncorrected). T1 values increased significantly in the left hippocampus, amygdala, caudate nucleus, right pallidum, thalamus, and bilateral putamen (P=0.02, 0.040, 0.01, <0.001, 0.03, 0.04, 0.004, uncorrected). The left hippocampus showed significantly increased T2 values (P=0.03, uncorrected). In contrast, the PD values increased significantly in the left amygdala, nucleus accumbens, right pallidum, putamen, bilateral caudate nucleus, and thalamus (P=0.02, 0.041, 0.01, 0.006, 0.007, 0.03, 0.047, 0.009, uncorrected). After FDR correction, significant differences persisted in the bilateral thalamic volume, T1 values of left caudate, right putamen and pallidum, PD values of left amygdala, right pallidum, putamen, bilateral caudate nucleus, and thalamus. ROC curve analysis revealed significant differences in bilateral thalamic volume, T1 values of left caudate nucleus, right putamen and pallidum, PD values of left amygdala, caudate nucleus, right putamen, pallidum, and thalamus between OSA patients and controls (P=0.002, 0.001, 0.01, 0.007, <0.001, 0.02, 0.007, 0.01, 0.01, 0.03; AUC 0.668-0.770). After controlling for age, body mass index (BMI), and years of education, OSA patients showed negative correlations between visual space and executive function and the right putamen T1 and PD values (r=-0.390, -0.449; P=0.045, 0.02) and positive correlations with the left amygdala PD value (r=0.397; P=0.04). No significant differences were found in partial correlation analysis after FDR correction.
SyMRI offers sensitive detection of abnormal volume and relaxation value changes in subcortical gray matter nuclei among patients with moderate to severe OSA. These findings provide valuable imaging information for quantifying subcortical gray matter nuclei damage in OSA and advancing our understanding of the neuropathological mechanisms underlying cognitive impairment.
阻塞性睡眠呼吸暂停（OSA）是一种相对常见的睡眠障碍，可损害脑结构并引发认知障碍。我们旨在使用合成磁共振成像（SyMRI）评估中度至重度OSA患者皮质下灰质核团的体积和弛豫值变化。
招募了30例经多导睡眠监测（PSG）新诊断的中度至重度OSA患者，以及30例年龄、性别、教育程度和利手匹配的健康对照（HC）。所有参与者均接受蒙特利尔认知评估（MoCA）量表测试。两组均使用3.0T磁共振扫描仪进行常规MRI、三维T1加权脑容积（3D T1-BRAVO）和SyMRI检查。扫描后，使用SyMRI8.0软件对原始SyMRI数据进行后处理，以自动生成T1、T2和质子密度（PD）定量图，并使用SPM12软件（Matlab R2015b）获取皮质下灰质核团。比较两组之间的认知量表评分、皮质下灰质核团体积和弛豫定量值。使用错误发现率（FDR）对体积和弛豫定量值进行多重比较校正。对具有统计学显著差异的SyMRI定量参数进行受试者操作特征（ROC）分析，以计算曲线下面积（AUC）。在OSA组中，分析异常脑体积和弛豫值变化与MoCA评分之间的相关性，使用FDR进行多重比较和校正。
与对照组相比，OSA组双侧丘脑体积显著减小（P=0.002，0.003，未校正）。左侧海马体、杏仁核、尾状核、右侧苍白球、丘脑以及双侧壳核的T1值显著升高（P=0.02，0.040，0.01，<0.001，0.03，0.04，0.004，未校正）。左侧海马体的T2值显著升高（P=0.03，未校正）。相比之下，左侧杏仁核、伏隔核、右侧苍白球、壳核、双侧尾状核和丘脑的PD值显著升高（P=0.02，0.041，0.01，0.006，0.007，0.03，0.047，0.009，未校正）。经FDR校正后，双侧丘脑体积、左侧尾状核、右侧壳核和苍白球的T1值、左侧杏仁核、右侧苍白球、壳核、双侧尾状核和丘脑的PD值仍存在显著差异。ROC曲线分析显示，OSA患者与对照组之间在双侧丘脑体积、左侧尾状核、右侧壳核和苍白球的T1值、左侧杏仁核、尾状核、右侧壳核、苍白球和丘脑的PD值方面存在显著差异（P=0.002，0.001，0.01，0.007，<0.001，0.02，0.007，0.01，0.01，0.03；AUC 0.668 - 0.770）。在控制年龄、体重指数（BMI）和教育年限后，OSA患者的视觉空间与执行功能与右侧壳核T1和PD值呈负相关（r=-0.390，-0.449；P=0.045，0.02），与左侧杏仁核PD值呈正相关（r=0.397；P=0.04）。FDR校正后的偏相关分析未发现显著差异。
SyMRI能够灵敏检测中度至重度OSA患者皮质下灰质核团的异常体积和弛豫值变化。这些发现为量化OSA患者皮质下灰质核团损伤以及增进我们对认知障碍潜在神经病理机制的理解提供了有价值的影像学信息。
