Thalamic neurometabolite alterations in chronic low back pain: a common phenomenon across musculoskeletal pain conditions?

ABSTRACT: Recently, we showed that patients with knee osteoarthritis (KOA) demonstrate alterations in the thalamic concentrations of several metabolites compared with healthy controls: higher myo-inositol (mIns), lower N-acetylaspartate (NAA), and lower choline (Cho). Here, we evaluated whether these metabolite alterations are specific to KOA or could also be observed in patients with a different musculoskeletal condition, such as chronic low back pain (cLBP). Thirty-six patients with cLBP and 20 healthy controls were scanned using 1 H-magnetic resonance spectroscopy (MRS) and a PRESS (Point RESolved Spectroscopy) sequence with voxel placement in the left thalamus. Compared with healthy controls, patients with cLBP demonstrated lower absolute concentrations of NAA ( P = 0.0005) and Cho ( P < 0.05) and higher absolute concentrations of mIns ( P = 0.01) when controlling for age, as predicted by our previous work in KOA. In contrast to our KOA study, mIns levels in this population did not significantly correlate with pain measures (eg, pain severity or duration). However, exploratory analyses revealed that NAA levels in patients were negatively correlated with the severity of sleep disturbance ( P < 0.01), which was higher in patients compared with healthy controls ( P < 0.001). Additionally, also in patients, both Cho and mIns levels were positively correlated with age ( P < 0.01 and P < 0.05, respectively). Altogether, these results suggest that thalamic metabolite changes may be common across etiologically different musculoskeletal chronic pain conditions, including cLBP and KOA, and may relate to symptoms often comorbid with chronic pain, such as sleep disturbance. The functional and clinical significance of these brain changes remains to be fully understood.

Radiofrequency heating studies on anesthetized swine using fractionated dipole antennas at 10.5 T.

PURPOSE: To validate electromagnetic and thermal simulations with in vivo temperature measurements, and to demonstrate a framework that can be used to predict temperature increase caused by radiofrequency (RF) excitation with dipole transmitter arrays. METHODS: Dipole arrays were used to deliver RF energy in the back/neck region of the swine using different RF excitation patterns (n = 2-4 per swine) for heating. The temperature in anesthetized swine (n = 3) was measured using fluoroscopic probes (n = 12) and compared against thermal modeling from animal-specific electromagnetic simulations. RESULTS: Simulated temperature curves were in agreement with the measured data. The root mean square error between simulated and measured temperature rise at all locations (at the end of each RF excitation) is calculated as 0.37°C. The mean experimental temperature rise at the maximum temperature rise locations (averaged over all experiments) is calculated as 2.89°C. The root mean square error between simulated and measured temperature at the maximum temperature rise location is calculated as 0.57°C. (Error values are averaged over all experiments.) CONCLUSIONS: Electromagnetic and thermal simulations were validated with experiments. Thermal effects of RF excitation at 10.5 Tesla with dipoles were investigated. Magn Reson Med 79:479-488, 2018. © 2017 International Society for Magnetic Resonance in Medicine.