Xiong Jianmei, Liu Mengqi, Li Xin, Chen Zhiye
Department of Neurology, Hainan Hospital of PLA General Hospital, Sanya, 572013, China.
Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, 572013, China.
Brain Imaging Behav. 2025 Jun 3. doi: 10.1007/s11682-025-01020-x.
Numerous studies have demonstrated that the locus coeruleus (LC) is activated by acute, nociceptive pain and plays an important role in the management of chronic pain. The purpose of this study was to assess the morphology and cerebral blood flow (CBF) changes in the LC of chronic migraine (CM) patients and explore the associations between these changes and the clinical features of these patients via three-dimensional pseudocontinuous arterial spin labelling (3D PCASL) in order to better elucidate the role of the LC in the pathophysiology of CM. Thirteen patients diagnosed with CM at the Department of Neurology, Hainan Hospital of PLA General Hospital, from May 2020 to June 2021 were prospectively included, and fifteen age- and sex-matched normal controls (NCs) were enrolled. All participants underwent psychoneurological assessments and brain structural and 3D PCASL MRI examinations. Brain region volume and CBF alterations were assessed, their associations with clinical scores were analysed, and receiver operating characteristic (ROC) curve analysis was conducted to determine the variables that best differentiated between the groups. No significant differences were found in the total volume of the LC between CM patients and NCs (P > 0.05). Compared with that in the NCs, the CBF of the bilateral LCs was lower in CM patients; the difference on the right side was statistically significant (P = 0.031). Correlation analysis revealed a negative correlation between the CBF of the LC and disease duration (in years). ROC curve analysis revealed that the area under the curve of the CBF of the right LC was 0.749 (95% CI 0.563-0.935), and the optimal cut-off value, sensitivity, and specificity in distinguishing CM patients from NCs were 49.67 ml/100 mg/min, 0.53 and 0.92, respectively. Hypoperfusion of the bilateral LC was observed in CM patients and contributes to the understanding of the pathogenesis of CM. 3D PCASL could serve as a useful tool for diagnosing and assessing CM.
大量研究表明，蓝斑（LC）会被急性伤害性疼痛激活，并在慢性疼痛的管理中发挥重要作用。本研究的目的是评估慢性偏头痛（CM）患者蓝斑的形态和脑血流量（CBF）变化，并通过三维伪连续动脉自旋标记（3D PCASL）探索这些变化与患者临床特征之间的关联，以便更好地阐明蓝斑在CM病理生理学中的作用。前瞻性纳入了2020年5月至2021年6月在解放军总医院海南医院神经内科诊断为CM的13例患者，并纳入了15例年龄和性别匹配的正常对照（NC）。所有参与者均接受了精神神经评估以及脑结构和3D PCASL MRI检查。评估脑区体积和CBF改变，分析它们与临床评分的相关性，并进行受试者操作特征（ROC）曲线分析以确定最能区分两组的变量。CM患者和NC之间蓝斑的总体积无显著差异（P>0.05）。与NC相比，CM患者双侧蓝斑的CBF较低；右侧差异具有统计学意义（P = 0.031）。相关性分析显示蓝斑的CBF与病程（年）呈负相关。ROC曲线分析显示，右侧蓝斑CBF的曲线下面积为0.749（95%CI 0.563 - 0.935），区分CM患者与NC的最佳截断值、敏感性和特异性分别为49.67 ml/100 mg/min、0.53和0.92。在CM患者中观察到双侧蓝斑灌注不足，这有助于理解CM的发病机制。3D PCASL可作为诊断和评估CM的有用工具。
