美国国家生物医学成像与生物工程研究所Carlo Pierpaoli团队研究了涉及异常健康事件的美国政府人员及对照人群的神经影像学。2024年3月18日出版的《美国医学会杂志》发表了这项成果。

美国驻海外的政府人员报告了异常健康事件（AHIs），一些人出现了持续的衰弱症状。为了与匹配良好的对照组相比，评估AHI参与者可能存在的磁共振成像（MRI）可检测的脑损伤，2018年6月至2022年11月，研究组在美国国立卫生研究院（NIH）临床中心和NIH MRI研究机构进行了一项探索性研究。

对81名患有AHI的参与者和48名年龄和性别匹配的对照参与者进行了临床、脑体积和功能MRI评估，其中29名与AHI组从事相似工作。在不同期间还获得了高质量的扩散MRI扫描和第二次体积扫描。对结构MRI采集方案进行了优化，以实现高再现性。49名AHI参与者在第一次就诊后约6至12个月内至少进行了1次额外的成像治疗。研究组从多种模式获得组级定量指标：（1）体积测量，体素取向和感兴趣区域（ROI）；（2） 扩散MRI衍生的指标，体素取向和ROI；和（3）使用功能MRI的网络内静息状态功能连接的ROI。探索性数据分析使用标准、非参数检验和贝叶斯多级模型。

81名AHIs患者的平均年龄（SD）为42（9）岁，49%为女性；在48名对照组参与者中，平均（SD）年龄为43（11）岁，42%为女性。最早在经历AHI后14天进行成像扫描，中位延迟期为80天（IQR，36-544）。经过多次比较校正后，在任何MRI模式下，AHI参与者和对照参与者之间都没有发现显著差异。在未调整的阈值（P < .05），与对照组参与者相比，患有AHI的参与者在显著性网络中的网络内连接较低，胼胝体较大，胼胝质、上纵束、扣带、小脑下核和杏仁核的扩散MRI差异较大。

结构MRI测量具有高度可重复性（所有全局体积ROI的中值变异系数<1%，扩散指标的所有白质ROI的中值变动系数<1.5%）。即使与对照组参与者有很大差异的个体也表现出稳定的纵向结果（通常，每次就诊<±1%），这表明没有演变中的病变。影像学和临床变量之间的关系较弱（Spearmanρ中值 = 0.10）。该研究没有复现先前发表的AHI调查结果。

研究结果表明，在这项探索性神经影像学研究中，在对多重比较进行校正后，报告AHIs的个体和匹配的对照参与者在大脑结构或功能的影像学测量方面没有显著差异。

附：英文原文

Title: Neuroimaging Findings in US Government Personnel and Their Family Members Involved in Anomalous Health Incidents

Author: Carlo Pierpaoli, Amritha Nayak, Rakibul Hafiz, M. Okan Irfanoglu, Gang Chen, Paul Taylor, Mark Hallett, Michael Hoa, Dzung Pham, Yi-Yu Chou, Anita D. Moses, André J. van der Merwe, Sara M. Lippa, Carmen C. Brewer, Chris K. Zalewski, Cris Zampieri, L. Christine Turtzo, Pashtun Shahim, Leighton Chan, NIH AHI Intramural Research Program Team, Brian Moore, Lauren Stamps, Spencer Flynn, Julia Fontana, Swathi Tata, Jessica Lo, Mirella A. Fernandez, Annie Lori-Joseph, Jesse Matsubara, Julie Goldberg, Thuy-Tien D. Nguyen, Noa Sasson, Justine Lely, Bryan Smith, Kelly A. King, Jennifer Chisholm, Julie Christensen, M. Teresa Magone, Chantal Cousineau-Krieger, Louis M. French, Simge Yonter, Sanaz Attaripour, Chen Lai

Issue&Volume: 2024-03-18

Abstract:

Importance  US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.

Objective  To assess the potential presence of magnetic resonance imaging (MRI)–detectable brain lesions in participants with AHIs, with respect to a well-matched control group.

Design, Setting, and Participants  This exploratory study was conducted at the National Institutes of Health (NIH) Clinical Center and the NIH MRI Research Facility between June 2018 and November 2022. Eighty-one participants with AHIs and 48 age- and sex-matched control participants, 29 of whom had similar employment as the AHI group, were assessed with clinical, volumetric, and functional MRI. A high-quality diffusion MRI scan and a second volumetric scan were also acquired during a different session. The structural MRI acquisition protocol was optimized to achieve high reproducibility. Forty-nine participants with AHIs had at least 1 additional imaging session approximately 6 to 12 months from the first visit.

Exposure  AHIs.

Main Outcomes and Measures  Group-level quantitative metrics obtained from multiple modalities: (1) volumetric measurement, voxel-wise and region of interest (ROI)–wise; (2) diffusion MRI–derived metrics, voxel-wise and ROI-wise; and (3) ROI-wise within-network resting-state functional connectivity using functional MRI. Exploratory data analyses used both standard, nonparametric tests and bayesian multilevel modeling.

Results  Among the 81 participants with AHIs, the mean (SD) age was 42 (9) years and 49% were female; among the 48 control participants, the mean (SD) age was 43 (11) years and 42% were female. Imaging scans were performed as early as 14 days after experiencing AHIs with a median delay period of 80 (IQR, 36-544) days. After adjustment for multiple comparisons, no significant differences between participants with AHIs and control participants were found for any MRI modality. At an unadjusted threshold (P<.05), compared with control participants, participants with AHIs had lower intranetwork connectivity in the salience networks, a larger corpus callosum, and diffusion MRI differences in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior cerebellar peduncle, and amygdala. The structural MRI measurements were highly reproducible (median coefficient of variation <1% across all global volumetric ROIs and <1.5% for all white matter ROIs for diffusion metrics). Even individuals with large differences from control participants exhibited stable longitudinal results (typically, <±1% across visits), suggesting the absence of evolving lesions. The relationships between the imaging and clinical variables were weak (median Spearman ρ=0.10). The study did not replicate the results of a previously published investigation of AHIs.

Conclusions and Relevance  In this exploratory neuroimaging study, there were no significant differences in imaging measures of brain structure or function between individuals reporting AHIs and matched control participants after adjustment for multiple comparisons.

DOI: 10.1001/jama.2024.2424

Source: https://jamanetwork.com/journals/jama/fullarticle/2816532