Cine MRI during spontaneous cramps in women with menstrual pain.
Cine MRI during spontaneous cramps in women with menstrual pain.
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DOI：
10.1016/j.ajog.2018.01.035
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发表时间：
2018-05
影响因子：
9.8
通讯作者：
Prasad PV
中科院分区：
文献类型：
--
作者：
Hellman KM;Kuhn CS;Tu FF;Dillane KE;Shlobin NA;Senapati S;Zhou X;Li W;Prasad PV
由于缺乏非侵入性的方法来研究痛经，导致对疼痛机制的理解不足，诊断测试不足，治疗选择有限。为了解决这一知识缺口，我们开发了一种基于MRI的策略，用于持续监测子宫与参与者自发疼痛感知的关系。本研究的目的是评估MRI是否可以检测痛经女性痉挛发作期间子宫肌层活动的实时变化，并使用手持挤压球报告疼痛。16名痛经妇女和10名健康对照妇女在不服用止痛药的情况下进行了MRI检查。使用单次激发HASTE序列沿着获得连续MRI，同时使用挤压球报告疼痛严重程度。Pearson系数用于比较评审员之间的结果。采用Fisher精确检验评估痛经妇女和对照组月经开/关之间的比例差异。信号变化之间的时间关系进行了评估与Monte Carlo模拟。子宫肌层信号强度的自发性进行性降低在月经期妇女中比在月经期妇女或无痛经的妇女中更常见（p < 0.01）。月经期子宫肌层信号强度没有降低的妇女要么有子宫内膜异位症病史，要么没有疼痛。两名对月经疼痛或白天状态不知情的评估者之间一致报告了子宫肌层事件的观察结果（r=0.97，p<0.001）。痉挛发作发生在子宫肌层信号改变之前或之后32- 70秒（p <0.05）。子宫肌层T2加权信号强度的短暂降低可以可靠地测量月经痛妇女。信号变化的方向性和与疼痛发作的时间关系表明，痉挛性疼痛可能是由子宫压力和血流动力学功能障碍的组合引起的。
The lack of non-invasive methods to study dysmenorrhea has resulted in poor understanding of the mechanisms underlying pain, insufficient diagnostic tests, and limited treatment options. To address this knowledge gap, we have developed an MRI-based strategy for continuously monitoring the uterus in relation to participants’ spontaneous pain perception. The study objective was to evaluate whether MRI can detect real-time changes in myometrial activity during cramping episodes in women with dysmenorrhea, with a hand-held squeeze bulb for pain reporting. Sixteen women with dysmenorrhea and ten healthy control women both on and off their menses were evaluated with MRI while not taking analgesic medication. Continuous MRI was acquired using single-shot HASTE sequence along with simultaneous reporting of pain severity with a squeeze bulb. Pearson’s coefficient was used to compare results between reviewers. Proportional differences between women with dysmenorrhea and controls on/off menses were evaluated with Fisher’s exact test. The temporal relationships between signal changes were evaluated with Monte Carlo simulations. Spontaneous progressive decreases in myometrial signal intensity were more frequently observed in women on their menses than in the absence of pain in the same women off their menses or participants without dysmenorrhea (p’s < 0.01). Women without reductions in myometrial signal intensity on their menses either had a history of endometriosis or were not in pain. Observations of myometrial events were consistently reported between two raters blinded to menstrual pain or day status (r=0.97, p<0.001). Episodes of cramping occurred either immediately before or 32–70s after myometrial signal change onset (p’s <0.05). Transient decreases in myometrial uterine T2-weighted signal intensity can be reliably measured in women with menstrual pain. The directionality of signal change and temporal relationship to pain onset suggest that cramping pain may be caused by a combination of uterine pressure and hemodynamic dysfunction.
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影响因子：
6.1
作者：
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通讯作者：
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影响因子：
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作者：
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