Multimodal MRI Study On The Effect Of Acupuncture At Fengchi Acupoint On Dizziness/vertigo Caused By Abnormal Posterior Circulation Hemodynamic

1 Objective1.1 To explore the alterations of brain function by resting-state functional magnetic resonance imaging(rs-fMRI)in dizziness/vertigo patients with abnormal posterior circulation hemodynamics,and provide information for their diagnosis.1.2 To observe the changes of gray matter volume(GMV)in dizziness/vertigo patients with abnormal posterior circulation hemodynamics,explore the structural changes of dizziness in such patients,and provide information for their diagnosis and treatment.1.3 To observe the immediate brain effect of acupuncture at Fengchi on resting-state fMRI in dizziness/vertigo patients with abnormal posterior circulation hemodynamics,and to explore the mechanism of acupuncture for dizziness.1.4 To observe the changes of ASL and IVIM in dizziness/vertigo patients with abnormal posterior circulation hemodynamic,and explore the microcirculation changes of the patients.To observe the effect of acupuncture at Fengchi on ASL and IVIM,and explore the microcirculation effect of acupuncture at Fengchi for dizziness/vertigo.2 Methods2.1 Twenty dizziness/vertigo patients with abnormal posterior circulation hemodynamics and 12 healthy controls were enrolled.All subjects underwent rs-fMRI scan.Based on dpabi software,one sample T-test was used to analyze the alteration of regional homogeneity(ReHo),the amplitude of low-frequency fluctuation(ALFF),fraction amplitude low frequency fluctuation(fALFF)and functional connectivity between the two groups.2.2 Twenty dizziness/vertigo patients with abnormal posterior circulation hemodynamics and twelve healthy controls were enrolled.All subjects underwent 3D-TWI1 scan.Based on dpabi software,one sample T-test was used to analyze the changes of the gray matter volume between the two groups.Pearson’s correlation coefficient was used to analyze the correlation between the altered gray matter volume and DHI score and disease course.2.3 Twenty dizziness/vertigo patients with abnormal posterior circulation hemodynamics were enrolled and randomly divided into acupuncture group and sham-acupuncture group.Rs-fMRI scans were performed before and after acupuncture.Based on dpabi software,paired T-test was used to analyze the changes of ALFF,VMHC and FC before and after acupuncture in the two groups.Pearson’s correlation coefficient was used to analyze the correlation between the altered ALFF,VMHC and DHI score.2.4 Twenty dizziness/vertigo patients with abnormal posterior circulation hemodynamics and twelve healthy controls were enrolled,ASL and IVIM scans were performed for all subjects.The patients were randomly divided into acupuncture group and sham-acupuncture group.ASL and IVIM scans were repeated after acupuncture.T-test was used to analyze the changes of the cerebral blood flow(CBF),relative cerebral blood flow(rCBF),diffusion coefficient(D),perfusion coefficient(D*)and perfusion fraction(f)between patients and healthy controls.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of IVIM parameters for patients.Paired T-test was used to analyze the changes of the cerebral blood flow(CBF),relative cerebral blood flow(rCBF),diffusion coefficient(D),perfusion coefficient(D*)and perfusion fraction(f)in patients before and after acupuncture.3 Results3.1(1)Compared with the healthy control group,the increased ReHo in patients were mainly shown in the right cerebellum and right putamen;the brain areas with decreased ReHo value were mainly located in the right supramarginal gyrus/right postcentral gyrus,left middle occipital gyrus and right cuneus.(2)The increased ALFF were mainly shown in the right putamen/caudate,and the decreased ALFF were mainly shown in the right middle occipital gyrus/right calcarine and right supramarginal gyrus/right postcentral gyrus.(3)The decreased fALFF was mainly located in the right middle temporal gyrus.(4)the functional connection(FC)between the right cuneus and the right middle frontal gyrus/superior frontal gyrus were decreased;the decreased FC were found between right supramarginal gyrus/right postcentral gyrus and bilateral superior frontal gyrus,the right supplementary motor brain area and the left cuneus,and the FC between right supramarginal gyrus/right postcentral gyrus and the right cerebellum was enhanced.The FC between right middle occipital gyrus/right calcarine and the right supplementary motor brain area was decreased,the FC between right middle occipital gyrus/right calcarine and the left cerebellum was enhanced;FC between the right putamen/caudate nucleus and the right insula was enhanced;FC between the right middle temporal gyrus and the right superior temporal gyrus was decreased,FC between the right middle temporal gyrus and the right cerebellum was increased;FC between the right insula and the left cerebellum was increased.3.2(1)Compared with the healthy control group,the decreased GMV in patients were shown in the right cingulum-mid gyrus/right precuneus,left lingual gyrus/left inferior occipital gyrus,right inferior temporal gyrus/right middle temporal gyrus,left postcentral gyrus/left supramarginal gyrus,left superior frontal gyrus and left superior temporal.(2)The GMV of left lingual gyrus/inferior occipital gyrus was negatively correlated with disease course.3.3(1)Compared with the sham-acupuncture group,the ALFF value increased in the left superior frontal gyrus,caudate nucleus and left precuneus in the acupuncture group,and decreased in the left middle occipital gyrus,right inferior occipital gyrus and left cerebellum.(2)The ALFF in the left superior frontal gyrus was negatively correlated with the DHI score.(3)The FC between the left precuneus and the right middle frontal gyrus,superior frontal gyrus was enhanced in the acupuncture group;the FC between the left precuneus and the paracentral and the right cerebellum was decreased;FC between the right hippocampus and the left superior frontal gyrus and left superior occipital gyrus were enhanced.(4)The VMHC values increased in the inferior temporal lobe,superior parietal gyrus and precuneus.There was no correlation between the altered VMHC and DHI scores.3.4(1)Compared with the healthy control group,the decreased CBF and rCBF of the cerebellum and cuneus were found in the patient group.Among the patients,hypoperfusion areas were found in the cerebellum in 15 patients and in the cuneus in 12 patients,accounting for 75%and 60%of all patients,respectively.(2)The decreased D*value were mainly in the vermis and the right superior temporal gyrus,and the increased D*value was in the left superior frontal gyrus;the decreased f value was in the vermis and the right superior temporal gyrus,and the increased f was mainly in the left superior frontal gyrus;the decreased D values were mainly in the left middle temporal gyrus,and the increased D value were mainly in the cerebellar follicle and right insula.(3)The ROC of D*in vermis,f value in right superior temporal gyrus and D*in left superior frontal gyrus showed that the AUC was 0.93,the corresponding sensitivity was 0.92,the specificity was 0.83.(4)After acupuncture at Fengchi,the CBF and rCBF of the cerebellum and cuneus were increased;the D*value of the bilateral cerebellum was increased,and the f value of the left superior frontal gyrus was increased.4 Conclusion4.1 The alterations of brain function were found in this research,which mainly related with vestibular,visual,and motor-related cortex.This characteristic activity pattern may relate to the pathogenesis of dizziness/vertigo.4.2 The changes of GMV were mainly related with vestibular and visual brain regions in dizziness/vertigo patients with abnormal posterior circulation hemodynamics,suggesting that these brain regions may be the key pathological brain regions.4.3 This study identified specific alterations of ALFF,VMHC and FC after acupuncture at Fengchi,suggesting that acupuncture can regulate vestibular,visual and motor-related cortical functional activities at multiple nodes,and regulate interhemispheric functional connectivity,which may be an important brain function basis for acupuncture treatment.4.4 The ASL and IVIM parameters of dizziness/vertigo patients with abnormal posterior circulation hemodynamics were abnormal,suggesting that these patients has the mechanism of abnormal microcirculation perfusion.acupuncture for dizziness/vertigo has the effect of modulating microcirculatory perfusion.