Grey and white matter alteration in patients with patent foramen ovale: A cross-sectional observational study using combined surface-based morphometry and voxel-based morphometry.

Patent foramen ovale (PFO) is closely associated with migraine. However, the mechanism remains unclear. Surface-based morphometry (SBM) and voxel-based morphometry (VBM) were widely used to study microstructural changes in the brain. We aimed to use SBM and VBM to investigate microstructural changes in the brain in migraineurs with PFO. A total of 20 migraineurs were enrolled in the PFO group, and 20 TCD-negative migraineurs, matched by gender and similar age, were included in the control group. All patients underwent brain MRI. 3D-T1-WI imaging was used to reconstruct and post-process for VBM and SBM analysis. There were no significant differences in their baseline clinical characteristics. VBM results showed that white matter (WM) volumes decreased in six relevant brain regions in the PFO group: cerebellar vermis VIII, right caudate, left superior temporal gyrus, left fusiform, left posterior cingulate gyrus, and left postcentral gyrus (P < .05 or P < .01). Also, the gray matter (GM) volumes of the bilateral hippocampus were significantly decreased in the PFO group (P < .01). Furthermore, SBM results showed that the cortex of the right superior frontal gyrus was thicker, the sulcus of the right rostral middle frontal gyrus was deeper, and the fractal dimension of the left superior parietal gyrus was more complex in the PFO group, but these results couldn't pass FDR correction (P > .05). This cross-sectional study demonstrates that migraine patients with PFO exhibit focal gray and white matter volume reductions in multiple pain, cognition, and emotion-related brain regions. These structural alterations may represent important neural substrates underlying PFO-related migraine.