[논문]Reproducibility Between two physicians of fMRI study on the Brain Activity Induced by Acupuncture (at BL62)

Yeo, S.; Kim, Y.; Choe, I.H.; Rheu, K.H.; Choi, Y.G.; Hong, Y.M.; Lim, S.

Reproducibility Between two physicians of fMRI study on the Brain Activity Induced by Acupuncture (at BL62) 원문보기

경락경혈학회지= Korean journal of acupuncture, v.26 no.2, 2009년, pp.39 - 51

Yeo, S. (Meridian and Acupoint, Grad. Sch. of Basic Eastern Med. Science, Kyung Hee Univ.) , Kim, Y. (Meridian and Acupoint, Grad. Sch. of Basic Eastern Med. Science, Kyung Hee Univ.) , Choe, I.H. (Applied Meridian Med., Grad. Sch. of Applied Eastern Medicine, Kyung Hee Univ.) , Rheu, K.H. (Applied Meridian Med., Grad. Sch. of Applied Eastern Medicine, Kyung Hee Univ.) , Choi, Y.G. (Acupuncture and Meridian, WHO Collaborating Ctr. for Traditional Medicine, East-West Med. Res. Institute, Kyung Hee Univ.) , Hong, Y.M. (Meridian and Acupoint, Grad. Sch. of Basic Eastern Med. Science, Kyung Hee Univ.) , Lim, S. (Meridian and Acupoint, Grad. Sch. of Basic Eastern Med. Science, Kyung Hee Univ.)

초록
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목적 : 신맥 혈위 자극이 뇌활성화 변화에 미치는 영향에 있어 자침 시술자간의 재현성을 fMRI 영상을 통해 평가하고자 하였다. 방법 : 본 연구는 건강한 성인 남자 15명을 대상으로 실시하였으며, 15명의 피험자 중 7명은 각각 2회 방문하였으며, 두 시술자에 의해 침을 맞고 총 4개의 데이터를 얻었다. 나머지 8명은 1회 방문하여 두 시술자에게 침을 맞아 2개씩의 데이터를 얻어 총 44개의 fMRI 데이터를 얻었다. 실험자간의 차이를 줄이기 위해 자침의 깊이와 회전, 강도 등을 동일하게 하였으며, 우측 신맥혈에 자침하였다. 침에 의해 활성화되는 영역을 확인하기 위해 블록디자인을 사용하여 fMRI를 촬영하였다. 결과 : 다른 날에 실시한 같은 시술자내의 재현성은 24 %, 같은 날 실시한 다른 시술자간의 재현성은 64 % 로, 다른 시술자간의 재현성이 서로 다른 날 실시한 같은 시술자내의 재현성보다 높게 나타났다. 결론 : 침을 이용한 fMRI의 실험에서 시술자에 의한 차이 외에도 실험하는 날짜의 차이, 피험자 인체의 생리적인 변화 등에 의한 차이가 크다는 것을 본 실험을 통하여 확인하였다. 그리고 자침의 깊이와 회전, 자극의강도 등을 동일하게 함으로써 다른 시술자간의 재현성을 높일 수 있다는 것을 확인했다. 추후 침실험에 있어서 여러 변수들에 의한 차이를 극복하고 재현성을 높일 수 있는 방법에 관한 더욱 심도 있는 연구가 필요하다.

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가설 설정

1. The mean intra-physician reproducibility was 64%. When the right BL62 was stimulated by two physicians, the brain deactivation of the anterior lobe was significantly reproduced.
80% and 83.79% in Table 4. Interphysician reproducibility in the retest is higher than in the test. The mean is 64%.

제안 방법

About one month later acupuncture administration was performed by the same physicians(P1,P2) and same manner, and brain activities were scanned to investigate the intraphysician’s reproducibility.
After a rest period of 60 seconds, acupuncture manipulation was repeated in the same manner and another 60 second rest period followed. During the test, two physicians(P1,P2) performed acupuncture on each subject in the same scanning session, the order of physicians was randomized. There was a 3-5minute intermission between each session.
Images were acquired with a three-tesla MRI scanner(ISOL Tech, Kyunggido, Korea) that allows the researchers to perform echo planar imaging(EPI). BOLD functional imaging was obtained using a gradient echo T2 * weighted pulse sequence(TE = 25 ms, TR = 3000 ms, 180 images per slice, matrix = 64 × 64, field of view[FOV] = 220 ㎜, flip angle=90 degrees).
First, the interphysician reproducibility was measured using two physicians. In the test two physicians(P1, P2) performed acupuncture one after the other in the same fMRI scanning session. In the Retest about 1 month later, the same physicians(P1, P2) administered acupuncture treatment and brain activities of test and retest of same physician (intraphysician) were also compared.
15 test data results and 7 retest data results were analyzed with this method. The anterior ROI region which includes the frontal lobe activated from the test and the posterior ROI region which includes the parietal lobe and occipital lobe activated from the retest were analyzed. Comparison of the changing personal signal intensity ratios measures were assessed with Wilcoxon test, excluding those areas that exceeded the corrected p-value 0.
All subjects signed the informed consent. The subjects were instructed on the rules for fMRI imaging and on the experimental procedure, including acupuncture. They were also told that in three separate, randomly selected sessions, their brain would be scanned to measure the response to acupuncture stimulation.
Even though these acupuncture studies using fMRI have lots of merits, the results have some problems about reproducibility and reliability. These studies are affected by physician, subjects, acupoint, kind of acupuncture, stimulus type and retention of acupuncture etc., so it is difficult to get a reproducible and reliable correlation between brain activity and specific acupoints. For example, Siedentopf et al.

대상 데이터

The acupoint selected for the experiment wasright BL62. BL62 is located on the lateral aspect of foot, directly inferiorto the prominence of the lateral malleolus, in the depresstion between the inferior border of the lateral malleolus and the calcaneus.
The data analysis program used wasBrain Voyager 2000(R. Goeble and Max Planck Society, Brain Innovation B.V., Maastricht, Netherlands). To correct for the subject’s motion, MR images were realigned using a 3-D motion correction program.
This study was carried out on 15 healthy right-handed subjects. The subjects were all Korean men between the ages of 20 and 30. The local ethics committee of Kyung Hee University approved this study.
This study was carried out on 15 healthy right-handed subjects. The subjects were all Korean men between the ages of 20 and 30.

이론/모형

The local ethics committee of Kyung Hee University approved this study. All subjects met the guidelines for MRI imaging issued by Korean Advanced Institute of Science and Technology(KAIST). No subjects had head trauma, consciousness failure, or other illnesses.
BOLD signal by GLM method sorting significantly active region was analyzed. The mean Image data was taken for group analysis and was analyzed by GLM method.
To correct for the subject’s motion, MR images were realigned using a 3-D motion correction program.

성능/효과

2. The low reproducibility deduced from the same physician was because the difficulty in controlling the variable produced by the subject. As the result of acupuncture is affected by the patient's condition, the subject's biological state also affects the brain activity.
3. Respectively there was not a significant intraphysician difference between signal changes (p>0.05).

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