| Objective:To draw and analysis the first 3D brain structure map of Cushing’s disease,based on imaging big data and AccuBrain NeuroImage Quantification System(ANQS)web system,and the true volume of each anatomical brain area was calculated quantitatively,and the differences in the whole brain structure between Cushing’s disease and normal population were compared.Using by far the largest prospective longitudinal cohort in the current field,we intend to investigate the presence of remodeling in the brain after transsphenoidal surgery,and to depict the dynamic changes in the 3D structure of all brain regions and their correlation with clinical and hormonal parameters.Methods:50 consecutive patients with pathologically confirmed CD from the Department of Neurosurgery of Peking Union Medical College Hospital were prospectively included.And 36 normal control groups matched for gender and age were include as healthy controls.Complete clinical and multimodal image data were collected.All CD patients underwent transsphenoidal pituitary adenoma resection and 3 months post-op follow-up were taken for complete data resampling.The data was analyses post-processed useing the ANQS web system.The computer uses machine learning algorithms to automatically extract MRI biomarkers.Based on the image big data,the whole brain three-dimensional structure is reconstructed and automatically segmented,and the volume of each brain area is quantitatively measured and statistically analyzed.Results:Abnormalities in the whole brain 3D structure were observed in CD patients,including total brain gray matter,frontal lobe,parietal lobe,occipital lobe,temporal lobe,insula and cingulate gyrus(P<0.05*),lateral ventricle and third ventricles were abnormally enlarged(P<0.05*)and were closely related to high cortisol status(P<0.05*).After transsphenoidal surgery,all brain structures of pre-operative abnormal atrophy in CD patients were significantly larger than before surgery(P<0.05*),and the abnormal ventricullar system was significantly smaller than before surgery(P<0.001**).After 3 months of follow-up,the total volume of gray matter in the cured CD group was restored to normal levels(P>0.05),confirming the remodeling of the whole brain 3D structure.The rapid remodeling area(bilateral parietal lobe,bilateral occipital lobe,bilateral insula,cingulate gyrus)had been restored to normal levels(P>0.05).The slow remodeling area(bilateral frontal lobe,bilateral temporal lobe)was significantly restored before surgery(frontal lobe:P<0.001**,temporal lobe:P<0.05*),but it was still different from normal(P<0.05*).In the process of brain remodeling,the correlation between ACTH and brain structural changes is the most closely related,and its significant correlation is widely reflected in total brain grey matter(r=-0.363,P=0.014*),frontal lobe(r=-0.407,P=0.006**),temporal lobe(r=-0.487,P=0.001**),island leaf(r=-0.295,P=0.049*),and hippocampus(r=-0.396,P=0.007**);The changes of F were related to frontal lobe(r=-0.308,P=0.040*),temporal lobe(r=-0.352,P=0.018*),hippocampus(r=-0.607,P<0.001**)and amygdala(r=-0.310,P=0.038*);In the process of brain remodeling,24hUFC changes and changes in brain structure was minimally correlated,only in the left temporal lobe(r=-0.350,P = 0.021*)and left hippocampus(r=-0.347,P=0.023*).Conclusions:In the short-term(3 months)after transsphenoidal surgery,CD patients can return to the normal level in the whole brain.This is the first time that the existence of brain structural remodeling has been confirmed in CD.In the postoperative brain remodeling process,the simultaneous presence of rapid remodeling and slow remodeling areas explained the clinically cured CD patients with incomplete reversible mental disorders,memory decline,and cognitive impairment.Due to the important role in the brain remodeling process,clinical assessment of CD patients should pay more attention to the recovery of ACTH and F levels. |
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