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Ito A, Yang S, Shinto E, Shinto A, Toyofuku A, Kurata J. Interhemispheric and Corticothalamic White-Matter Dysfunction Underlies Affective Morbidity and Impaired Pain Modulation in Chronic Pain. Anesth Analg 2024:00000539-990000000-00827. [PMID: 38837907 DOI: 10.1213/ane.0000000000006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Although patients with chronic pain show behavioral signs of impaired endogenous pain modulation, responsible cerebral networks have yet to be anatomically delineated. We used diffusion tensor imaging (DTI) to examine the white-matter alterations in patients with chronic pain compared with healthy subjects. We further measured thermal pain modulatory responses using the offset analgesia (OA) paradigm. We tested whether the white-matter indices be associated with psychophysical parameters reflecting morbidity and modulatory responses of pain in patients, and whether they could serve as diagnostic biomarkers of chronic pain. METHODS Twenty-six patients with chronic pain and 18 age- and gender-matched healthy controls were enrolled. After completing psychophysical questionnaires, they underwent OA measurement and whole-brain DTI in a 3 Tesla magnetic resonance imaging scanner. Fractional anisotropy (FA) and radial diffusivity (RD) of the white-matter were computed and compared between the groups with tract-based spatial statistics using the FMRIB Software Library (FSL) software. Correlations were sought among white-matter indices, thermal pain responses, and psychophysical parameters. The white-matter indices and OA-related parameters were tested whether they distinguish patients from controls by receiver operating characteristic analysis. RESULTS During OA, patients showed a shorter latency to the maximum (maximum visual analog scale [VAS] latency, 16.0 ± 3.7 vs 18.9 ± 3.1 second [mean ± standard deviation, SD]; P = .032) but a longer latency to the minimum pain (OA latency, 15.6 ± 3.5 vs 11.1 ± 4.2 seconds; P = .004) than controls. They showed a smaller mean FA (0.44 ± 0.12 vs 0.45 ± 0.11; P = .012) and a larger mean RD of the global white-matter (0.00057 ± 0.00002 vs 0.00056 ± 0.00002; P = .038) than controls, at specific areas including the corpus callosum, anterior thalamic radiation, and forceps major. FA of the splenium of the corpus callosum was associated with maximum VAS latency (r = 0.493) and OA latency (r = -0.552). The Pain Catastrophizing Scale scores showed strong negative correlations with FA across those specific areas (r = -0.405). Those latencies during OA and white-matter metrics distinguished patients from controls (P < .05). CONCLUSIONS Patients with chronic pain showed dysfunction of the white matter concerned with interhemispheric communication of sensorimotor information as well as descending corticothalamic modulation of pain in association with affective morbidity and altered temporal dynamics of pain perception. We suggest that an impaired interhemispheric modulation of pain, through the corpus callosum, might be a novel cerebral mechanism in chronification of pain.
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Affiliation(s)
- Atsushi Ito
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Sushuang Yang
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Eri Shinto
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Shinto
- Department of Anesthesiology, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Akira Toyofuku
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Jiro Kurata
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of Anesthesiology, Keio University Graduate School of Medicine, Tokyo, Japan
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Xu H, Liu Y, Zeng WT, Fan YX, Wang Y. Distinctive cortical morphological patterns in primary trigeminal neuralgia: a cross-sectional clinical study. Neuroradiology 2024; 66:207-216. [PMID: 38001310 DOI: 10.1007/s00234-023-03257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The characteristics of surface-based morphological patterns to primary trigeminal neuralgia (PTN) are still not well understood. This study aims to screen the useful cortical indices for the prediction of PTN and the quantification of pain severity. METHODS Fifty PTN patients and 48 matched healthy subjects enrolled in the study from March 2016 to August 2021. High-resolution T1 data were performed at 3.0 Tesla scanner and were analyzed with FreeSurfer software to detect the abnormalities of cortical mean curve (CMC), cortical thickness (CT), surface area (SA), and cortical volume (CV) in PTN patients compared to healthy controls. Logistic regression analysis was conducted to determine whether certain morphological patterns could predict PTN disorder. Then, the relationships of cortical indices to the pain characteristics in patient group were examined using linear regression model. RESULTS Distinctive cortical alterations were discovered through surface-based analysis, including increased temporal CMC, decreased insular CT and fusiform SA, along with decreased CV in several temporal and occipital areas. Moreover, the difference of temporal CMC was greater than other cortical parameters between the two groups, and the combination of certain morphological indices was of good value in the diagnosis for PTN. Besides, CT of left insula was negatively associated with the pain intensity in PTN patients. CONCLUSION The patients with PTN demonstrate distinctive morphological patterns in several cortical regions, which may contribute to the imaging diagnosis of this refractory disorder and be useful for the quantification of the orofacial pain. CLINICAL TRIALS The registry name of this study in https://clinicaltrials.gov/ : Magnetic Resonance Imaging Study on Patients with Trigeminal Neuralgia (MRI-TN) https://clinicaltrials.gov/ ID: NCT02713646 A link to the full application: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02713646&cntry=&state=&city=&dist= The first patient with primary trigeminal neuralgia was recruited on November 28, 2016.
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Affiliation(s)
- Hui Xu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Yang Liu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Wen-Tao Zeng
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yu-Xin Fan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yuan Wang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Lan X, Zhu XY, Bai WX, Liu HP, Wang H, Dun WH, Guo CG, Zhang M, Niu X. White matter changes in young and middle-aged males with chronic prostatitis/chronic pelvic pain syndrome: Tract-based spatial statistics analysis. Eur J Neurosci 2023; 58:3892-3902. [PMID: 37779210 DOI: 10.1111/ejn.16154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
The supraspinal mechanism plays a key role in developing and maintaining chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, it is not clear how white matter changes in young and middle-aged males with CP/CPPS. In this cross-sectional study, 23 CP/CPPS patients and 22 healthy controls (HCs) were recruited. Tract-based spatial statistics was applied to investigate the differences in diffusion tensor imaging metrics, including fractional anisotropy (FA), mean diffusion (MD), radial diffusion (RD) and axial diffusion (AD), between CP/CPPS patients and HCs. The study also examined the association between white matter alterations and clinical variables in patients using correlation analysis. Compared with HCs, patients showed decreased FA, MD, RD and AD in the body and genu of the corpus callosum and right anterior corona radiata. In addition, they showed increased FA along with decreased MD, RD and AD in the left posterior limb of the internal capsule (PLIC-L), left external capsule and left cerebral peduncle. The FA of PLIC-L was negatively correlated with disease duration (r = -.54, corrected p = .017), while MD and RD were positively correlated (r = .45, corrected p = .042; r = .57, corrected p = .017). These results suggest that CP/CPPS is associated with extensive changes in white matter tracts, which are involved in pain processing. In particular, the FA, MD and RD values in the PLIC-L were correlated with the disease duration, indicating that the long-term course of CP/CPPS may have effects on the white matter microstructure of the pain perception pathways.
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Affiliation(s)
- Xi Lan
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin-Yi Zhu
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei-Xian Bai
- Department of Medical Imaging, Xi'an NO.3 Hospital, Affiliated Hospital of Northwest University, Xi'an, China
| | - Hui-Ping Liu
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- School of Future Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- School of Future Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wang-Huan Dun
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chen-Guang Guo
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuan Niu
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Branco P, Bosak N, Bielefeld J, Cong O, Granovsky Y, Kahn I, Yarnitsky D, Apkarian AV. Structural brain connectivity predicts early acute pain after mild traumatic brain injury. Pain 2023; 164:1312-1320. [PMID: 36355048 DOI: 10.1097/j.pain.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
ABSTRACT Mild traumatic brain injury (mTBI), is a leading cause of disability worldwide, with acute pain manifesting as one of its most debilitating symptoms. Understanding acute postinjury pain is important because it is a strong predictor of long-term outcomes. In this study, we imaged the brains of 157 patients with mTBI, following a motorized vehicle collision. We extracted white matter structural connectivity networks and used a machine learning approach to predict acute pain. Stronger white matter tracts within the sensorimotor, thalamiccortical, and default-mode systems predicted 20% of the variance in pain severity within 72 hours of the injury. This result generalized in 2 independent groups: 39 mTBI patients and 13 mTBI patients without whiplash symptoms. White matter measures collected at 6 months after the collision still predicted mTBI pain at that timepoint (n = 36). These white matter connections were associated with 2 nociceptive psychophysical outcomes tested at a remote body site-namely, conditioned pain modulation and magnitude of suprathreshold pain-and with pain sensitivity questionnaire scores. Our findings demonstrate a stable white matter network, the properties of which determine an important amount of pain experienced after acute injury, pinpointing a circuitry engaged in the transformation and amplification of nociceptive inputs to pain perception.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Noam Bosak
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Olivia Cong
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yelena Granovsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Itamar Kahn
- Department of Neuroscience and Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, United States
| | - David Yarnitsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Xu H, Zhou Y, Wang J, Liang Z, Wang Y, Wu W, Liu Y, Liu X, Zhang X, Huo L. Effect of HD-tDCS on white matter integrity and associated cognitive function in chronic schizophrenia: A double-blind, sham-controlled randomized trial. Psychiatry Res 2023; 324:115183. [PMID: 37028258 DOI: 10.1016/j.psychres.2023.115183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/09/2023]
Abstract
Schizophrenia is a disabling major mental disorder, which includes critical deficits in cognitive function, for which no effective intervention currently exists. The aim of our double-blind, randomized, sham-controlled trial was to evaluate the effects of high-definition transcranial direct current stimulation (HD-tDCS) on the cognitive deficits in schizophrenia. This study sample consisted of 56 individuals with chronic schizophrenia, randomly allocated to either the active stimulation or sham group. The treatment consisted of ten consecutive days of HD-tDCS, 20 min/day, applied over the left dorsolateral prefrontal lobe. Changes in clinical outcomes, cognitive assessments, and diffusion tensor imaging were evaluated pre- to post-intervention. Matched-healthy controls (HCs) were included to identify white matter changes in patients with schizophrenia before treatment. Compared to HCs, schizophrenia was associated with reduced integrity of the white matter tracts of the corpus callosum and corona radiata. HD-tDCS enhanced integrity in the corpus callosum and anterior and superior corona radiata, which was associated with the change in cognitive performance. HD-tDCS offers a potential approach to improve cognition deficits in schizophrenia through a modulatory effect on white matter tracts. Given the lack of approved treatments for cognitive deficits, these findings are clinically relevant.
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Affiliation(s)
- Hui Xu
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education, Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China; Peter Boris Centre for Addictions Research, McMaster University, Hamilton, Canada
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zhen Liang
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yang Wang
- College of Management, Shenzhen University, Shenzhen, China
| | - Weibin Wu
- The Third People's Hospital of Foshan, Foshan, China
| | - Yiliang Liu
- The Third People's Hospital of Foshan, Foshan, China
| | - Xia Liu
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xin Zhang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Lijuan Huo
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education, Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
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Sun R, Zhang SY, Cheng X, Xie S, Qiao PG, Li GJ. White matter structural and network topological changes in moyamoya disease with limb paresthesia: A study based on diffusion kurtosis imaging. Front Neurosci 2022; 16:1029388. [PMID: 36389234 PMCID: PMC9659737 DOI: 10.3389/fnins.2022.1029388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To investigate the structural and network topological changes in the white matter (WM) in MMD patients with limb paresthesia by performing diffusion kurtosis imaging (DKI). Materials and methods A total of 151 MMD patients, including 46 with left-limb paresthesia (MLP), 52 with right-limb paresthesia (MRP), and 53 without paresthesia (MWP), and 28 healthy controls (HCs) underwent whole-brain DKI, while the surgical patients were reexamined 3-4 months after revascularization. The data were preprocessed to calculate the fractional anisotropy (FA) and mean kurtosis (MK) values. Voxel-wise statistics for FA and MK images were obtained by using tract-based spatial statistics (TBSS). Next, the whole-brain network was constructed, and global and local network parameters were analyzed using graph theory. All parameters were compared among the HC, MWP, MLP, and MRP groups, and changes in the MMD patients before and after revascularization were also compared. Results The TBSS analysis revealed significant reductions in FA and MK in extensive WM regions in the three patient groups. In comparison with the MWP group, the MLP group showed reductions in FA and MK in both right and left WM, mainly in the right WM, while the MRP group mainly showed a reduction in FA in the left WM region and demonstrated no significant change in MK. The graph theoretical analysis showed decreased global network efficiency, increased characteristic path length, and increased sigma in the MWP, MRP, and MLP groups in comparison with the HC group. Among local network parameters, the nodal efficiency decreased in the bilateral MFG and IFGtriang, while the degree decreased in the MFG.L and bilateral IFGtriang. Patients with right-limb paresthesia showed the lowest nodal efficiency and degree in MFG.L and IFGtriang.L, while those with left-limb paresthesia showed the lowest nodal efficiency in MFG.R and IFGtriang.R and the lowest degree in IFGtriang.R. Conclusion A DKI-based whole-brain structural and network analysis can be used to detect changes in WM damage and network topological changes in MMD patients with limb paresthesia. FA is more sensitive than MK in detecting WM injury, while MFG and IFGtriang are the key nodes related to the development of acroparesthesia.
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Affiliation(s)
- Rujing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shi-Yu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xu Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Sangma Xie
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Peng-Gang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
- *Correspondence: Peng-Gang Qiao,
| | - Gong-Jie Li
- Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
- Gong-Jie Li,
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Xu H, Zhang M, Wang Y. Shape deformations of the basal ganglia in patients with classical trigeminal neuralgia: a cross-sectional evaluation. Neurol Sci 2022; 43:5007-5015. [PMID: 35471744 DOI: 10.1007/s10072-022-06091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/19/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Despite the involvement of subcortical brain structures in the pathogenesis of classic trigeminal neuralgia (CTN), the details of morphological abnormalities of basal ganglia to this disorder are still unknown. This study aimed to investigate potential changes in terms of volume and shape of subcortical regions in patients with CTN. METHODS Forty-eight patients with CTN and 46 matched healthy subjects were recruited in the study. The whole-brain T1 anatomical data was acquired at a 3.0 Tesla scanner using a fast spoiled gradient recalled sequence (FSPGR). Vertex-wise analysis was applied to detect the alterations of volume and shape in each subcortical region in the patients with CTN compared to healthy controls. The relationships of morphological abnormalities in subcortical structures to the severity of orofacial pain and the affective disturbance in the patient group were examined using the multiple linear regression model. RESULTS No group difference was found about volumetric measurement in any of the subcortical regions. Vertex-wise analysis revealed areas of significant shape atrophy in bilateral putamen and bilateral pallidum in the patients with CTN compared to healthy controls. Besides, the patient group exhibited shape expansion in the head of the right caudate nucleus compared to healthy subjects. In addition, shape deformation in the head of the right caudate nucleus was positively associated with VAS score in CTN. CONCLUSION The patients with CTN display shape alterations in the specific subregions of basal ganglia, which may contribute to the pathophysiology of this refractory disorder and may be useful for translational medicine.
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Affiliation(s)
- Hui Xu
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ming Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yuan Wang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Zhang Y, Furst AJ. Brainstem Diffusion Tensor Tractography and Clinical Applications in Pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:840328. [PMID: 35399154 PMCID: PMC8989264 DOI: 10.3389/fpain.2022.840328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
The brainstem is one of the most vulnerable brain structures in many neurological conditions, such as pain, sleep problems, autonomic dysfunctions, and neurodegenerative disorders. Diffusion tensor imaging and tractography provide structural details and quantitative measures of brainstem fiber pathways. Until recently, diffusion tensor tractographic studies have mainly focused on whole-brain MRI acquisition. Due to the brainstem's spatial localization, size, and tissue characteristics, and limits of imaging techniques, brainstem diffusion MRI poses particular challenges in tractography. We provide a brief overview on recent advances in diffusion tensor tractography in revealing human pathways connecting the brainstem to the subcortical regions (e.g., basal ganglia, mesolimbic, basal forebrain), and cortical regions. Each of these pathways contains different distributions of fiber tracts from known neurotransmitter-specific nuclei in the brainstem. We compare the brainstem tractographic approaches in literature and our in-lab developed automated brainstem tractography in terms of atlas building, technical advantages, and neuroanatomical implications on neurotransmitter systems. Lastly, we summarize recent investigations of using brainstem tractography as a promising tool in association with pain.
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Affiliation(s)
- Yu Zhang
- War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States,*Correspondence: Yu Zhang ;
| | - Ansgar J. Furst
- War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, United States,Polytrauma System of Care (PSC), VA Palo Alto Health Care System, Palo Alto, CA, United States
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