fmri在功能性慢性内脏痛研究中的进展

1、1会计学fmri在功能性慢性内脏痛研究中的进展在功能性慢性内脏痛研究中的进展计算机体层成像计算机体层成像(CT)20世纪5060年代7080年代8090年代19世纪末20世纪初 X 线 放射诊断学正电子发射成像(PET)单光子发射体层成像(SPECT)磁共振功能成像（FMRI）超声成像(USG)核素 闪烁成像 (-scintigraphy)计算机体层成像(CT)磁共振成像(MRI)数字血管减影(DSA)194619731992199119771990取得了临床MRI 扫描器的专利；Mansfield使用回波成像(EPI)序列更快的得到图像Felix Bloch和Edward Purcell分别

2、发现了核磁共振(Nuclear Magnetic Resonance)现象Lauterbur提出NMR 可以用来成像Ogawa 通过T2加权像观察到BOLD 效应 Belliveau 首次通过对比机制观察到功能图像 Ogawa & Kwong发表了通过BOLD 信号成像的结果capillary含氧血红蛋白去氧血红蛋白Blood Oxygen Level Depend功能性慢性内脏痛IBSCRDEmeran a. Mayer et al., Gastroenterology(2006)C C稳态传入网络包括：臂旁核、丘脑、岛叶、dACC等。1.4.1稳态传入网络（homeostatic-

3、 afferent network）Figure 1. Ascending projections of homeostatic afferents. (B) Spino-thalamo-cortical system. (C) Cortical modulation of homeostatic afferent input to the central nervous system.Fig. 2. Cortical-affective circuit effective connectivity model.J.S. Labus et al. Pain(2013) 情绪-觉醒环路: 杏仁核

4、、蓝斑复合体、嘴侧/膝下/膝上扣带回等；皮层处理环路:前额叶皮质、眶颞额叶皮质等。Fig. 3. Sex differences in activation of the homeostatic afferent, emotionalarousal, and corticalmodulatory networks in response to noxious visceral stimulation. MaleFemaleZ. Wang et al.,Pain(2009)1.4.3 内脏刺激脑部环路联系Figure 4. ReHo differences between IBS patient

5、s and controls. J. KE et al., Neurogastroenterol Motil (2015) 中央后回、丘脑、小脑蚓、顶叶 aMCC、pACC、sACC、vm/dl/vlPFCFigure .5. Rectal distension-induced neural activation in the cingulate cortex (A) and the somatosensory cortex (S1/S2, B).Julia Schmid et al.,Neurogastroenterology(2015)MCC、岛叶、丘脑、杏仁核PCCS1、小脑S2S1、S

6、2Figure 6. Major sites of activation differences between irritable bowel syndrome (IBS) and healthy control subjects.C.L. Kwan et al., Neurology(2005)Figure 7. (AD) Brain activation in controls and IBS patients during subliminal and liminal rectal distensions. (E) Seed regions defined in the anterio

7、r insula (left) and aMCC (right) based on rectal distension-induced activation in the control group.(F) Seed regions defined similarly in the bilateral anterior insula (left) and pACC (right) in the IBS patient group.X. L IU，Neurogastroenterol Motil (2015)PCC、PAGaMCC、insula、dmPFC、caudate, and PAG感觉运

8、动皮质、 vmPFC运动皮质 SMA thalamus,SMA,下顶叶Figure 8. (A) Comparis on of brain activation between subliminal and liminal stimulation conditions in the control group. (B) The same in the IBS patient group. (C) Group comparis on of brain activation between controls and IBS patients during subliminal stimulatio

9、n. (D) The same during liminal stimulation.Figure 9 .(A and B) Functional connectivity of the insula seeds in the control and IBS gr oups during liminal stimulation. (C and D) The same in the aMCC (in controls ) and pACC (in IBS patients) seeds during liminal stimulation. (E and F) Group comparisons

10、 of insular and cingulate functional connectivity between controls and IBS patients. (IBS VS. controls: dmPFC, vmPFC, dl PFC, and PCC)dlPFCFig. 10. Sex differences (IBS + HC) for ME-MF (ME-MF = matching emotionmatching form) .J.S. Labus et al. Pain(2013) Fig.11. Disease and sex differences for ME-MF

11、. C. S. H Ubbard et al., Neurogastroenterol Motil (2015)Figure 12。 Statistical T maps for the region of interest analyses for the altering , orienting，and executive control conditions of the Attention Network Test (ANT) .Fig.13. Connections between the main areas activated during visceral perception

12、.X. Moisset et al.,European Journal of Pain (2010)三、fMRI在实验动物中的应用J. Lazovic et al.,Neurogastroenterol Motil (2005)Figure 14. Axial fMRI images of the rat brain at the pressures of 40 mmHg (A) 60 mmHg (B) and 80 mmHg (C), of the same animal. amygdalaHypothalamus（PVN）NTStrigeminal nucleusFigure 15 .Ax

13、ial fMRI images of the rat brain during the rectal balloon stimulation at the pressure of 60 mmHg (A) and 80 mmHg (B), of the same animal. SCPAGthalamusCblHiIL、PLFigure 16. Specific nuclei activated in rats with CORT (A and C) micropellets but not activated in rats with CHOL (B and D) （A、B：40 mmHg o

14、r；C、D：60 mmHg ）.Figure 17. Specific nuclei activated by 60 mmHg CRD but not at 40 mmHg CRD in rats with either CORT (C and D ) or CHOL (A and B)(A 、C:60 mmHg; B 、D: 40 mmHg).Anthony C. Johnson et al., Plos One(2010)Fig. 18. Comparison of changes in regional cerebral blood flow-related tissue radioac

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17、. Excessive coupling of the salience network with intrinsic neurocognitive brain networks during rectal distension in adolescents with irritable bowel syndrome: a preliminary reportJ. Neurogastroenterology & Motility, 2015.14.Makin T R, Filippini N, Duff E P, et al. Network-level reorganisation

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20、120:114122.18.Ke J, Qi R, Liu C, et al. Abnormal regional homogeneity in patients with irritable bowel syndrome: A resting-state functional MRI studyJ. Neurogastroenterology & Motility, 2015.19Schmid J, Langhorst J, Ga F, et al. Placebo analgesia in patients with functional and organic abdominal

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