title: Microvascular perfusion abnormalities of the Thalamus in painful but not painless diabetic polyneuropathy: a clue to the pathogenesis of pain in type 1 diabetes.
abstract: OBJECTIVE
  The pathogenesis of painful diabetic neuropathy (DN) remains undetermined, with both central and peripheral mechanisms implicated. This study investigates whether thalamic perfusion abnormalities occur in painful DN.
  
  
  METHODS
  Eighteen subjects with type 1 diabetes (no DN = 6, painful DN = 5, painless DN = 7) and six healthy volunteers (HV) were recruited. Microvascular perfusion characteristics (relative cerebral blood volume [rCBV], flow [rCBF], and transit time [tt(FM)]) of the thalamus and caudate nucleus were assessed using magnetic resonance perfusion imaging. The caudate nucleus was chosen to serve as an in vivo control region.
  
  
  RESULTS
  Subjects with painful DN had significantly greater thalamic rCBV (means [SD]; painful DN, 228.7 [19.5]; no DN, 202.3 [25.8]; painless DN, 216.5 [65.5]; HV, 181.9 [51.7]; P = 0.04) and the longest tt(FM)(s) (painful DN, 38.4 [3.6]; no DN, 35.3 [13.2]; painless DN, 35.9 [13.7]; HV, 33.7 [14.9]; P = 0.07). There was no significant difference in markers of caudate nucleus perfusion.
  
  
  CONCLUSIONS
  Painful DN is associated with increased thalamic vascularity. This may provide an important clue to the pathogenesis of pain in DN.
authors.affiliation: Diabetes Research Department, Royal Hallamshire Hospital, Sheffield, UK. dinesh.selvarajah@gmail.com
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selvarajah
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.forename: Paul D
authors.initials: PD
authors.lastname: Griffiths
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000503:physiopathology*; D010146:Pain / Q000209:etiology* / Q000503:physiopathology*; D013788:Thalamus / Q000503:physiopathology*