BACKGROUND AND OBJECTIVES Cushing's disease (CD) patients have metabolic abnormalities in the brain caused by excessive exposure to endogenous cortisol. However, the reversibility of brain metabolism of CD patients after treatment remains largely unknown. METHODS This study recruited 50 CD patients seeking treatment and 34 matched normal controls (NCs). The patients were treated with Transsphenoidal Adenomectomy (TSA) and reexamined 3 months later. Cerebral blood flow (CBF) of the patients was assessed using 3D pseudo-continuous arterial spin labelling (PCASL) imaging before the treatment and at the 3-month follow-up and were compared with CBF measure of the NCs using a whole-brain voxelwise group comparison method. For remitted patients, their CBF measures and hormone level measures, including adrenocorticotropic hormone (ACTH), 24-hour urinary free cortisol (24hUFC) and serum cortisol, were compared before and after the treatment. Finally, a correlation analysis was carried out to explore the relationship between changes of CBF and hormone level measures of the remitted CD patients. RESULTS After the treatment, 45 patients reached remission. Compared with the NCs, the CD patients before the treatment exhibited significantly reduced CBF in cortical regions, including occipital lobe, parietal lobe, superior/middle/inferior temporal gyrus, superior/middle/inferior frontal gyrus, orbitofrontal cortex, precentral gyrus, middle/posterior cingulate gyrus, and rolandic operculum, as well as significantly increased CBF in subcortical structures, including caudate, pallidum, putamen, limbic lobe, parahippocampal gyrus, hippocampus, thalamus, and amygdala (p < 0.01, false discovery rate corrected). For the remitted patients, the change in CBF before and after the treatment displayed a spatial pattern similar to the difference between the NCs and the CD patients before the treatment, and no significant difference in CBF was observed between the NCs and the remitted CD patients after the treatment. The changes of 24hUFC were significantly correlated with the changes of averaged CBF within the subcortical region in the remitted patients (p = 0.01). CONCLUSIONS Our findings demonstrate that the brain metabolic abnormalities of CD patients are reversible when their hormone level changes towards normal after surgery treatment.

中文翻译：

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库欣病患者手术治疗后脑血流的可逆性。


背景和目的库欣病（CD）患者因过度接触内源性皮质醇而导致大脑代谢异常。然而，CD患者治疗后脑代谢的可逆性仍然很大程度上未知。方法 本研究招募了 50 名寻求治疗的 CD 患者和 34 名匹配的正常对照 (NC)。患者接受经蝶腺瘤切除术（TSA）治疗，并于 3 个月后复查。在治疗前和 3 个月随访时使用 3D 伪连续动脉自旋标记 (PCASL) 成像评估患者的脑血流量 (CBF)，并与使用全脑体素测量的 NC 的 CBF 测量值进行比较分组比较法。对于缓解的患者，比较治疗前后的CBF测量和激素水平测量，包括促肾上腺皮质激素（ACTH）、24小时尿游离皮质醇（24hUFC）和血清皮质醇。最后，进行相关分析，探讨缓解后 CD 患者 CBF 变化与激素水平测量之间的关系。结果治疗后45例患者达到缓解。与NCs相比，治疗前CD患者的皮质区域CBF显着降低，包括枕叶、顶叶、颞上/中/下回、额上/中/下回、眶额皮质、中央前回、中/下回。后扣带回和罗兰盖，以及皮质下结构的 CBF 显着增加，包括尾状核、苍白球、壳核、边缘叶、海马旁回、海马、丘脑和杏仁核（p < 0.01，错误发现率已纠正）。 对于缓解的患者，治疗前后CBF的变化表现出与治疗前NC和CD患者之间的差异相似的空间模式，而治疗后NC和缓解的CD患者之间的CBF没有观察到显着差异。治疗。缓解患者24hUFC的变化与皮质下区域平均CBF的变化显着相关（p = 0.01）。结论 我们的研究结果表明，当手术治疗后激素水平恢复正常时，克罗恩病患者的大脑代谢异常是可逆的。