Clinical Application Of Resting State Functional Magnetic Resonance Imaging In Patients With Type 2 Diabetes Mellitus Complicated With Brainstem Infarction

Objective: The purpose of this study is to investigate the changes in resting brain function network in patients with Type 2 diabetes mellitus(T2DM)and brainstem infarction using the method of resting-state functional magnetic resonance imaging(rs-fMRI),including Regional Homogeneity(ReHo),Amplitude of low frequency fluctuation(ALFF),(Functional connectivity)FC,and to explore the possible intrinsic mechanism of its occurrence.Methods: A total of 13 patients with brainstem infarction in First Hospital Affiliated to University of South China from May 2017 to March 2018 were divided into two groups according to whether there is combined T2 DM.The T2 DM group included 6 cases with an average age of(67.0±6.8)years,non-T2 DM group included 7 cases with an average age of(63.3±15.3)years.11 cases of normal volunteers were selected as the normal control group matched with the age and with average age of(62.6±11.6)years.All participants used a variety of neurocognitive scales(MOCA,MMSE)for cognitive function testing.A whole-brain high-resolution magnetic resonance imaging was performed on all participants using the 3.0 Tesla PHILPS MRI imaging scanner.The sequences used included EPI,3D-T1,DWI,T1 WI and T2 WI.Using ReHo,ALFF and FC,observed differences in brain activity in the resting state in the experimental group(T2DM group,non-T2 DM group)and normal control group.This study uses the general software SPM8 based on MATLAB(The MathWorks,Natick,MA,USA)to perform data preprocessing.Collect clinical data such as age,gender,education level,and cognitive function scores of the subjects.The RESTplus_V1.2 was used to analyze the experimental data.The comparison between the experimental group and the normal control group was performed using a single sample t test and anova.The REST AlphaSim program was used to multiple comparison corrections to results.The difference was statistically significant at p<0.05.Results: Compared with the normal control group,the T2 DM group had decreased ALFF in the right postcentral grus,and increased ReHo in the right middle temporal gyrus and enhanced FC between the right postcentral grus with the right precuneus,the left posterior cingulate gyrus and the left median cingulate gyrus,and enhanced FC between the right middle temporal gyrus with the right inferior temporal gurus and the right temporal pole middle temporal gyrus.The non-T2 DM group had increased ALFF in the right postcentral grus,and decreased ReHo in the right middle temporal gyrus and the right inferior temporal gurus,and enhanced FC between the right postcentral grus with the right precuneus,left median cingulate gyrus,right paracentral lobule and right supplementary motor area,and reduced FC between the right middle temporal gyrus with the right inferior temporal gurus and the right temporal pole middle temporal gyrus.Compared with the non-T2 DM group,the T2 DM group had decreased ALFF in the right postcentral grus,and increased ReHo in the right middle temporal gyrus and right inferior temporal gurus,and decreased ReHo in the right cerebellum anterior lobe and reduced FC between the right postcentral grus with the left median cingulate gyrus,the right postcentral grus,the right paracentral lobule and the right supplementary motor area,and enhanced FC between the right middle temporal gyrus with the right inferior temporal gurus.Conclusions: The results of this study indicate that Brain function abnormalities and brain function network disorders appeared in the local brain regions and brain regions far away from the brainstem,When the brainstem occurs after ischemic cerebral infarction.T2 DM,as a risk factor for brain stem ischemic stroke,had a certain impact on brain function changes in patients with brainstem infarction.Changes in brain regions of ReHo,ALFF,and FC may reveal mechanisms associated with brain dysfunction in T2 DM and brainstem infarction.