Kado Hirotsugu, Kimura Hirohiko, Murata Tetsuhito, Nagata Ken, Kanno Iwao
Department of Radiology, Akita Research Institute for Brain and Blood Vessels, 6-10 Kubotamachi, Sensyu, Akita 010-0874, Japan.
Radiology. 2006 Jan;238(1):248-55. doi: 10.1148/radiol.2381041375.
To prospectively assess the usefulness of magnetic resonance (MR) spectroscopy data acquired before the initiation of medical therapy in predicting prognosis in patients with depressive psychosis.
All subjects gave written informed consent to an institutional committee for clinical research-approved study protocol. The clinical course after medication in 52 patients with depressive psychosis (age range, 52-78 years; 21 men, 31 women) was investigated. In all patients, MR spectroscopy was performed with a 1.5-T MR imaging unit before the initiation of medical therapy. Cerebrovascular lesions (CVLs), which appear as high-signal-intensity areas on T2-weighted MR images, were evaluated by using the Fazekas rating scale. Patients were classified into two groups on the basis of the ratio of N-acetylaspartate (NAA) to creatine and phosphocreatine (Cr): Patients in group A had an NAA/Cr ratio greater than 1.91, and patients in group B had an NAA/Cr ratio of 1.91 or less. To assess the response of the patients to medication, standard psychiatric tests--the Verbal Associative Fluency Test (VAFT), the Digit Symbol Test (DST), the Mini-Mental State Examination (MMSE), and the Hamilton Depression Rating Scale (HAM-D)--were administered before and after medical therapy was initiated. Mean test scores before and after medication were compared with paired t testing. P < .05 was considered to indicate a significant difference.
There were 25 patients in group A and 27 in group B. In group A, the mean VAFT and DST scores increased and the mean HAM-D score decreased after medication. There was no significant difference in mean MMSE scores before and after medication (P = .945 for group A and P = .934 for group B). In group B, there were no significant differences in any of the psychiatric test scores before and after medication. The high-signal-intensity area score in group B was significantly higher than that in group A (P = .004).
MR spectroscopy data obtained before the initiation of medical therapy were useful in predicting prognosis in patients with depressive psychosis; this suggests that the combined burden of all CVLs may affect the response to antidepressant medication.
前瞻性评估在药物治疗开始前获取的磁共振（MR）波谱数据对抑郁性精神病患者预后的预测价值。
所有受试者均书面知情同意一项经机构临床研究委员会批准的研究方案。对52例抑郁性精神病患者（年龄范围52 - 78岁；男性21例，女性31例）用药后的临床病程进行了研究。所有患者在药物治疗开始前均使用1.5-T MR成像设备进行了MR波谱检查。采用Fazekas评分量表评估在T2加权MR图像上表现为高信号强度区域的脑血管病变（CVL）。根据N - 乙酰天门冬氨酸（NAA）与肌酸和磷酸肌酸（Cr）的比值将患者分为两组：A组患者的NAA/Cr比值大于1.91，B组患者的NAA/Cr比值为1.91或更低。为评估患者对药物的反应，在开始药物治疗前后进行了标准精神科测试——言语联想流畅性测试（VAFT）、数字符号测试（DST）、简易精神状态检查表（MMSE）和汉密尔顿抑郁评定量表（HAM - D）。用药前后的平均测试分数采用配对t检验进行比较。P < 0.05被认为具有显著差异。
A组有25例患者，B组有27例患者。在A组，用药后平均VAFT和DST分数升高，平均HAM - D分数降低。用药前后平均MMSE分数无显著差异（A组P = 0.945，B组P = 0.934）。在B组，用药前后任何精神科测试分数均无显著差异。B组的高信号强度区域分数显著高于A组（P = 0.004）。
在药物治疗开始前获取的MR波谱数据对抑郁性精神病患者的预后具有预测价值；这表明所有CVL的综合负担可能影响对抗抑郁药物的反应。
