MRI Study On Brain Structural And Functional Connectivity Changes In Patients With Primary Insomnia

ObjectiveUsing Voxel-based morphometry （VBM） and Resting state functionalconnectivity magnetic resonance imaging（rs-fcMRI），we explored the changes ofbrain structure and function in primary insomnia （PI）patients.The purpose was toinvestigate the baseline character of neural activity in PI patients associated with thebrain functional and structural pathological mechanism of physioligical changes ordepressive disorder，to provide imaging information for clinical diagnosis andtreatment of PI.Materials and methodsThirty and untreated PI patients（according to the diagnostic criteria of thediagnostic and statistical manual of mental diseases，fourth edition（DSM-IV）of PI），fifteen patients with the mild-to-moderate depression symptoms （PID）and fifteenhealthy controls （NC）were underwent brain structures for three dimensional andresting state blood oxygen level-dependent magnetic resonance imaging examination. All the subjects were tested with clinical scale（PSQI、HAMA、 HAMD、RCFT）.TheVBM analysis was calculated by the SPM8in Matlab software,to compare the brainstructure differences of three groups; The resting state functional connectivityanalysis was calculated by the REST software, taking the bilateral anterior cingulatecortex（ACC）as seed regions, to compare the brain function connectivity differencesof three groups; SPSS17.0statistical software for statistical analysis, to correlativeanalysis between clinical scale scores and the brain functional connectivity ofabnormal areas.Result1General materials The three groups of different age, gender andeducation were not statistically significant（P＞0.05）.2VBM of result shows1、Compared to NC，PI patients showed decreased gray matter volume inInbilateral parietal, temporal lobes、Precuneus、Anterior cingulate cortex、Insula、Caudate、Left Lentiform Nucleus、orbital frontal cortex、Rectal Gyrus、SuperiorParietal Gyrus、Paracentral Lobule、Middle Occipital Gyrus、Hippocampus、Parahippocampal、 Cerebellar Peduncles、 Right Fusiform Gyrus、 Limbic Lobe/Cingulum_Post,the increased gray matter volume in Left Middle Temporal Gyrus inpatients（P＜0.001，cluster size＞50voxels）.2、Compared to NC，PID patients showed decreased gray matter volume inInbilateral Superior Frontal Gyrus/Supp_Motor_Area、 temporal lobes、 LimbicLobe/Anterior Cingulate、Precuneus、Cerebellum Posterior Lobe/Cerebelum₈、LeftFusiform Gyrus、 occipital lobe、 Cerebellum Anterior Lobe、 RightFrontal_Sup_Medial、Frontal_Inf_Oper、Angular/Supramarginal Gyrus，the increasedgray matter volume in Inbilateral Parietal Lobe/Postcentral、Left Middle FrontalGyrus、 Precentral Gyrus/Postcentral、 Brainstem/Midbrain、 Right TemporalLobe/Sub-Gyral、Occipital Lobe/Lingual、Limbic Lobe/Parahippocampa Gyrus inpatients（P＜0.001，cluster size＞50voxels）.3、Compared to PI，PID patients showed decreased gray matter volume in LeftFrontal_Inf_Oper、 Inferior Temporal Gyrus、 Cerebellum Posterior Lobe/Cerebelum₈、Cerebelum₁0、Right Superior Frontal Gyrus/Supp_Motor_Area、 Inferior Frontal Gyrus、 Angular/Superior Temporal Gyrus、 TemporalLobe/Sub-Gyral，the increased gray matter volume in Inbilateral Superior FrontalGyrus/Supp_Motor_Area、 temporal lobes、 Precuneus、 Cerebellum PosteriorLobe/Cerebelum₈、Left Fusiform Gyrus、Paracentral、occipital lobe Cingulum_Ant、Cerebellum Anterior Lobe、Right Middle Frontal Gyrus/Frontal_Inf_Oper、LimbicLobe/Anterior Cingulate/Medial Frontal Gyrus、 Inferior Temporal Gyrus、Angular/Supramarginal Gyrus in patients（P＜0.001，cluster size＞50voxels）.3RS-fcMRI of result shows3.1The brain regions showed functional connectivity with the bilateral ACCas seed regions1、The brain function neuronal networks of NC：Inbilateral Frontal lobes、ParietalLobe/Angular Gyrus、Right Supramarginal Gyrus/Superior Temporal Gyrus、LeftInter-Hemispheric/Cingulum_Mid、Right Limbic Lobe/Precuneus/Cingulate Gyrus、Left Limbic Lobe/Parahippocampa Gyrus、 Left Caudate/Insula/LentiformNucleus/Cingulum_Ant、Inbilateral temporal lobes showd positive correlation withACC， Inbilateral Frontal lobes、 Right parietal lobes、 RightOccipital_Mid/Occipital_Sup、 Left Inferior Temporal Gyrus/FusiformGyrus/Occipital_Mid、Right Occipital Lobe/Fusiform Gyrus/Lingual Gyrus/Inferior Temporal Gyrus、Left cerebellar hemispheres showd negative correlationwith ACC（P＜0.01，cluster size＞20voxels）.2、The brain function neuronal networks of PI：Left Frontal Lobe/MiddleFrontal Gyrus、Inbilateral parietal lobes、Left Temporal_Inf/Occipital_Inf/MiddleOccipital Gyrus、Right cerebellar hemispheres showd negative correlation with ACC，Left Anterior Cingulate/Superior Frontal Gyrus/Frontal_Sup_Medial/Inferior FrontalGyrus/Caudate/Lentiform Nucleus/Frontal_Mid/Frontal_Inf_Orb/Insula、InbilateralInferior Temporal Gyrus/Temporal_Mid、Left Parietal Lobe/Angular、Left ParietalLobe/Precuneus/Posterior Cingulate、 Right Limbic Lobe/Cingulate Gyrus/Cingulum_Mid showd positive correlation with ACC（P＜0.01，cluster size＞20voxels）.3、The brain function neuronal networks of PID：Inbilateral Superior ParietalLobule/Parietal_Sup/Parietal_Inf、 Left Precuneus、 Left Middle Frontal Gyrus/Precentral、Left Middle Occipital Gyrus/Temporal_Inf、Right CerebellumPosterior Lobe/Inferior Semi-Lunar Lobule/Cerebelum₇b showd negativecorrelation with ACC，Left Parietal Lobe/Angular Gyrus/Supramarginal Gyrus、LeftPosterior Cingulate/Precuneus、Right Caudate Head/Caudate、Left Medial FrontalGyrus/Anterior Cingulate/Superior Frontal Gyrus/Cingulum-Ant/Frontal-Sup-Medial/Cingulum-Mid/Paracentral Lobule showd positive correlation with ACC（P＜0.01，cluster size＞20voxels）.4、Compared to NC，PI patients showed negative correlation with ACC in RightTemporal_Inf、Right Parietal_Sup/Superior Parietal Lobule/Inferior Parietal Lobule、Left Limbic Lobe/Cingulate Gyrus， Left Cerebellum Anterior Lobe/Culmen/Lingual showd positive correlation with ACC（P＜0.01，cluster size＞20voxels）.5、Compared to NC，PID patients showed negative correlation with ACC inRight Brainstem/Midbrain、Left Middle Temporal Gyrus、Left Cerebellum PosteriorLobe/Cerebelum_Crus1，Left Parietal Lobe/Sub-Gyral/Rolandic_Oper、Left FrontalLobe/Sub-Gyral/Frontal_Inf_Tri、Right Parietal Lobe/Precuneus/Occipital_Mid、Right Parietal_Sup showd positive correlation with ACC（P＜0.01，cluster size＞20voxels）.6、Compared to PI，PID patients showed negative correlation with ACC in LeftCorpus Callosum/Cingulum_Post，Midbrain showd positive correlation with ACC（P＜0.01，cluster size＞20voxels）.3.2correlational analyses1、PI patients and NC group with the functional connectivity change in brainareas：Left Cingulate Gyrus、Left Lingual、Right Temporal_Inf、Right Parietal_Supwere not significantly associated with PSQI score（P＞0.05）.2、PID patients and NC group with the functional connectivity change in brainareas： Midbrain、 Left Middle Temporal Gyrus、 Left Cerebelum_Crus1weresignificantly negative correlations with PSQI score（P＜0.05），Left Rolandic_Oper、Left Frontal_Inf_Tri、Right Occipital_Mid、Right Parietal_Sup were not significantlyassociated with PSQI score（P＞0.05）.Others the brain functional connectivity ofabnormal areas were not significantly associated with HAMD score（P＞0.05）exceptRight Parietal_Sup was positive correlations with HAMD score（P＜0.05）. 3、PID patients and PI patients with the functional connectivity change in brainareas：Left Cingulum_Post was positive correlations with HAMD score（P＜0.05）,.Midbrain was not significantly associated with HAMD score（P＞0.05）.ConclusionCompared to NC，PI patients and PID patients had brain structure and functionalconnectivity of abnormal areas，it may be related to biological mechanisms of PIpathology; The functional connectivity of Left Anterior Cingulate/Insula、 LeftPosterior Cingulate、Right Limbic Lobe/Cingulate Gyrus/Cingulum_Mid increasedwith ACC in PI patients， compared to PI patients， Left Corpus Callosum/Cingulum_Post decreased with ACC in PID patients，frontal lobe、Limbic Lobeincreased with ACC，these supports PI patients with depressed mood had abnormalchanges of brain function neuronal networks; Brain morphological and function stateschanges can be reflected accurately and effectively through VBM、RS-fcMRI，toprovide image anatomy basis for neural cognitive research in PI.