Zhiwei Shen1, Yanlong Jia1, Tingting Nie1, Tao Zhang1, Gen Yan1, and Renhua Wu1
1The 2nd Affilited Hosptial of Shantou Universtiy Medical College, Shantou, China, People's Republic of
Synopsis
Diabetic peripheral neuropathy (DPN) is
one of the main complications of long-term diabetes and the incidence is 60% to
90%. However, there is no objective noninvasive method to detect the degree of damage of DPN and its pathogenesis remains unknown. Functional magnetic
resonance imaging (fMRI) has the advantages of high spatial and temporal
resolution, which had been used to detect neuron activity. In this study, the activation in the lumbar spinal cord of by electric stimulation were detected. Elevated activation percentage
changes of DPN were found and the activation changes have the correlated relatioship with blood biochemical indexes such as glucose, the total cholesterol and haemoglobin A1c.Aim
To detect the possible functional activation from
lumbar spinal cord by electric stimulation in patients with diabetic peripheral
neuropathy (DPN), and evaluate the relationship between the
activation and clinical blood biochemical indexes.
Materials and Methods
Twenty health volunteers (22-29 years old) and
twenty DPN patients (24-65 years old) were stimulated by a low frequency
electrical stimulator (intermittent pulse, frequency 20Hz) on anterolateral leg
skin to detect fMRI activation. Block design was used as activate pattern.
Functional spinal magnetic resonance images were acquired by a single-shot
fast spin echo (SSFSE) sequence based on signal enhancement by extra vascular
water protons (SEEP) effect. The number of active pixels was analyzed and the
signal intensity percent change was also calculated. The correlations between
activation and blood biochemical indexes, such as the total
cholesterol, haemoglobin A1c and GLU, were evaluated.
Results
In the sagittal plane,
activations from diabetic patients were mainly located in T12 (10/13) vertebral
level (Figure 1 and Figure 2). The signal intensity percent change was 2.93 ± 2.46% and the number of
active pixels was 5.14 ± 4.50. Compared with the control group, elevated
percentage change of signal intensity at T11 to L1 in diabetic patients were
found (2.93 ± 2.46% v.s. 1.63 ± 1.09% ) and the results had a statistically
significant difference (z=-2.745, p=0.006). However, the active pixels from the
DPN group had no statistically significant difference compared with the control
group.
The percentage
changes of signal intensity from the DPN group had a positive correlation with
the total cholesterol (T-CH, r=0.581, p=0.049) and glucose (GLU, r=0.597,
p=0.041), and a weak correlation with haemoglobin A1c (r=0.322, p=0.31) (Figure 3). The
active pixels from the DPN group had a positive correlation with GLU (r=0.380,
p=0.223) and HbA1c (r=0.323, p=0.305), but had a negative correlation with T-CH
(r=-0.112, p=0.729). Besides, there was no correlation with GLU in control
group for both the percentage changes of signal intensity (r=0.175, p=0.52) and
the active pixels (r=0.098, p=0.717) (Figure 4).
Conclusions
This study provided the data of lumbar spinal
cord fMRI during electrical stimulation. SEEP spinal cord fMRI may
has a great clinical value for the location of spinal cord function
of patients with diabetic neuropathy, therapeutic monitoring and treatment
guidance in the future.
Acknowledgements
This work was supported by the Key project of
national natural science foundation of china (Number: 30930027).References
1, Barry RL, Smith SA, Dula AN, et al. Resting state functional
connectivity in the human spinal cord. eLife.
2014;3(78):e02812
2, Cadotte DW, Bosma R, Mikulis D, Nugaeva N, Smith K, Pokrupa R, Islam O, Stroman PW, Fehlings MG. Plasticity of the injured human spinal cord: insights revealed by spinal cord functional MRI. PLoS One. 2012;7(9):e45560.
3, Malisza KL, Jones C, Gruwel ML, Foreman D, Fernyhough P, Calcutt NA. Functional magnetic resonance imaging of the spinal cord during sensory stimulation indiabetic rats. J Magn Reson Imaging. 2009 Aug;30(2):271-6.