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Evaluation of Migraine by Proton Magnetic Resonance Spectroscopy and Perfusion Weighted Imaging

Author: GuTao
Tutor: LiChuanFu
School: Shandong University
Course: Medical Imaging and Nuclear Medicine
Keywords: migraine animal model magnetic resonance spectroscopy trigeminal neuralgia magnetic resonance perfusion weighted imaging
CLC: R445.2
Type: PhD thesis
Year: 2007
Downloads: 252
Quote: 1
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Background and objectiveMigraine is one of most common disease in neurology with familia propersity and periodic episode. Its frequency and severe cephalalgia worsen the ability of studying and working and quality of living. It is also connected with some diseases such as stroke and dementia, tetraplegia and cacopathia. WHO defined severe migraine as most mutilation chronic disease. In present, migraine is diagnosed by subjective symptom in clinical, not by laboratory examination and special examination. Application of functional magnetic resonance imaging in neuroimaging improves the scope of study from simple morphology to molecular level and help to reveal the development mechanism of disease essentially. For example, magnetic resonance spectroscopy can evaluate the metabolism of local tissue, change of physiology and biochemistry and quantitative analysis of compound. Magnetic resonance perfusion weighted imaging can reflect the distribution of capillary vessel and perfusion of blood in tissue. Our studies focused on pathogenesis of migraine in three aspects. Objective one: using magnetic resonance spectroscopy to analyze brain tissue in migraine animal model in vivo and ex vivo, in order to compare the change of metabolism in vivo and ex vivo; verify correctness and reliability of examination in vivo and definite location with significant metabolism change. Objective two: using magnetic resonance spectroscopy to compare metabolism of thalami in migraine, trigeminal neuralgia and health enroller, in order to find characters of metabolism in migraine, supply clues to make research in aetiology and pathogensis of migraine and help to make clinical diagnosis and therapeutic evaluation. Objective three: using magnetic resonance spectroscopy and perfusion weighted imaging to study occipital lobe of migraine with visual disorder, in order to analyze metabolism change and perfusion of blood and provide evidence of aetiology research in visual alteration.Methods1. 24 adult Wistar rats were divided into experimental and control group. In experimental group, Nitroglycerin dissolved in saline was injected i.p. at a dose of 10mg/kg. The rats in control group were injected i.p. at the same dose of saline. Animal model was established successfully. Magnetic resonance spectroscopy examination was performed at GE Signa EXCITEⅡ3.0T MR scanner using a standard circular polarized animal coil. Stimulated echo acquisition mode was to perform single-voxel spectroscopy (TE=35ms). The volumes of interest were selected in the thalamus and cerebellum. The spectrum was processed by GE SAGE software to acquire the peak area of each metabolite. The ratios of MI, Cho, Cr, Glu and NAA to H2O were computed. After MR performance, rats were killed by decapitation. Brain was rapidly removed, placed into rat brain matrix and brain tissue including thalamus and cerebellum were obtained. Samples were placed in precooled plastic centrifuge tubes, frozen with dry ice. Magnetic resonance spectroscopy ex vivo was performed on a Bruker Avance 600 MHz (14.7T) MR spectrometer. The area of peak on metabolite concentration was acquired applying MestRec software. The ratios of MI, Cho, Cr, Glu and NAA to DSS were computed. The T-test was used.2. The study consisted of 20 migraine without aura, 16 trigeminal neuralgia and 14 health control subject. Magnetic resonance spectroscopy examination was performed at GE Signa EXCITEⅡ3.0T MR scanner using a standard birdcage head coil. Point resolved spectroscopy mode was to perform multi-voxel spectroscopy (TE=144ms). The volume of interest was selected in thalami. All raw data were conducted by Functool 3.1 software on GE ADW4.2 workstation. NAA/Cho, NAA/Cr and Cho/Cr were calculated and average metabolite concentration was computed. The T-test was used.3. 30 migraine consisted 13 migraine with aura, 7 migraine with visual disorder and 10 migraine without aura. 14 matched health control subjects were included in the experiment. Magnetic resonance spectroscopy examination was performed at GE Signa EXCITEⅡ3.0T MR scanner using a standard birdcage head coil. Point resolved spectroscopy mode was obtained to perform multi-voxel spectroscopy (TE=144ms). The volumes of interest were selected in occipital lobe. Flow-sensitive alternating invasion recovery mode was applied to evaluate perfusion of brain. All raw data were conducted by Functool 3.1 software on GE ADW4.2 workstation. Average NAA/Cho, Cho/Cr and NAA/Cr were calculated. rCBF perfusion images in occipital lobe were analyzed by two radiologist independently. Perfusion of blood was divided into three aspects: hypoperfusion, normal perfusion and hyperperfusion. ANOVA test was used to compare the ratios of metabolite between different perfusion group and different clinical appearance group. X2 test was applied to compare the occurrence of lactate in different brain perfusion groups and rCBF images in different clinical appearance groups.Results1. Magnetic resonance spectroscopy in migraine animal model in vivo showed the ratios for metabolite on Cho、Cr and Glu in thalami were higher than those in control group. There was no difference in ratios of MI and NAA to H2O between experiment and control group. Metabolite concentrations in cerebellum were no statistically difference between experimental group and control group.2. Magnetic resonance spectroscopy in migraine animal model ex vivo showed the ratios of Cho、Cr and Glu to DSS in thalami in experimental group were higher than those in control group. In contrast, the ratios of MI and NAA to DSS of the two groups were not different. Metabolite concentrations in cerebellum were no statistically difference between experimental group and control group.3. The metabolite concentration of Cho、Cr and Glu were increased obviously in thalami of experimental rats both in vivo and ex vivo. The consistency of both results was found.4. The results of magnetic resonance spectroscopy in thalami at migraine, trigeminal neuralgic and health subjects showed significant difference in NAA/Cho between migraine group and control group, in contrast to no difference in NAA/Cr and Cho/Cr. For trigeminal neuralgic group, NAA/Cho was lower than that of control group. For the affected side, the difference of NAA/Cho in migraine group was observed only in the left side, not in right side. However, the difference of NAA/Cr and Cho/Cr in trigeminal group was observed in both sides.5. In migraineurs with aura, abnormal perfusion was found in 9 subjects in occipital lobe including 6 hypoperfusion. Two abnormal perfusion were observed in migraine without aura and migraine with visual disorder, which showed hypoperfusion in migraine with visual disorder and hyperperfusion in migraine without aura. Lactate was detected in 8 subjects in hypoperfusion group and 7 subjects in normal perfusion. There were no difference in NAA/Cr, Cho/Cr and NAA/Cho between normal perfusion group and abnormal perfusion group. There was also no difference of metabolite concentration in occipital lobe among the different clinical appearance groups.Conclusion1. The elevated Cho and Cr spectral pattern was exhibited in rat migraine model. This proved the abnormal metabolism in brain when migraine attacks.2. The difference of metabolite concentration was found in thalami, not in cerebellum in migraine. This proved that thalamus plays an important role in mechanism of migraine and conduction of pain.3. The results found in magnetic resonance spectroscopy in vivo and ex vivo were observed consistent. This suggest that magnetic resonance spectroscopy in vivo may serve as a useful noninvasive tool to continuously survey and evaluate therapy of migraine in clinical practice.4. Migraine and trigeminal neuralgia were both associated with the trigeminal system. But there were some different metabolism in the thalami, which proved the pathology and pathway of pain were not quite the same.5. There was abnormal perfusion in occipital lobe in migraine with visual disorder. Hypoperfusion was mostly found in migraine with aura.6. Metabolism changes were not significantly different between migraine with aura and without aura in occipital lobe. 7. Anaerobic metabolism in brain was more easier to be detected by magnetic resonance spectroscopy than perfusion weighted imaging. There was also observed anaerobic metabolism in normal perfusion migraineurs.8. Every magnetic resonance technique has its own advantage. Combining multi-methods together may supply a new research method to explore the mechanism of migraine essentially.

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CLC: > Medicine, health > Clinical > Diagnostics > Diagnostic Imaging > Magnetic resonance imaging
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