Fountoulakis Konstantinos N, Giannakopoulos Panteleimon, Kövari Eniko, Bouras Constantin
3rd Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
Brain Res Rev. 2008 Nov;59(1):9-21. doi: 10.1016/j.brainresrev.2008.04.005. Epub 2008 Apr 12.
Most of the neuroanatomical models of bipolar disorder (BD) propose a key role for the anterior cingulate cortex (ACC). We provide here a review of currently available data regarding the CC neuroimaging and neuropathological alterations in BD.
After an exploratory search of the MEDLINE, we first identified all English-written articles that provide separate data for BD patients and report original experimental data on cingulate gyrus. Subsequently, we selected those including neuroimaging or neuropathological data. Among the 161 articles updated through June 2007, 81 articles were retained using this procedure.
The review of in vivo volumetric imaging data, as well as ex vivo morphometric and histological studies indicates that BD patients show volume changes of the subgenual ACC (sgACC-BA 25 and part of 24) during the early stages of the disease. Whether this phenomenon is due to neuronal and glial depletion or damage of corticocortical connections is still a matter of debate. The resting state activity in the left BA 25 appears to be state dependent showing significant increase during mania and decrease during depressive phases. The presence of a deficient GABAergic activity in ACC is also documented. Pharmacological treatment partly restores BD-related functional imaging changes.
The present review reveals the striking discrepancies of the experimental results present both for functional and structural imaging studies but also for neuropathological analyses. Methodological and conceptual limitations are addressed with particular reference to the heterogeneity of BD clinical patterns. We also critically discuss the validity of CC changes as possible trait- or state-markers of the disease.
大多数双相情感障碍（BD）的神经解剖学模型都认为前扣带回皮质（ACC）起关键作用。我们在此对目前有关BD中扣带回皮质的神经影像学和神经病理学改变的现有数据进行综述。
在对MEDLINE进行探索性检索后，我们首先确定了所有为BD患者提供单独数据并报告扣带回原始实验数据的英文文章。随后，我们选择了那些包含神经影像学或神经病理学数据的文章。在截至2007年6月更新的161篇文章中，通过该程序保留了81篇文章。
对活体容积成像数据以及离体形态学和组织学研究的综述表明，BD患者在疾病早期显示出膝下前扣带回皮质（sgACC - BA 25和部分24区）的体积变化。这种现象是由于神经元和神经胶质减少还是皮质皮质连接受损仍存在争议。左侧BA 25区的静息态活动似乎与状态有关，在躁狂期显著增加，在抑郁期减少。ACC中GABA能活性不足的情况也有记录。药物治疗部分恢复了与BD相关的功能成像变化。
本综述揭示了功能和结构成像研究以及神经病理学分析中实验结果存在明显差异。特别针对BD临床模式的异质性讨论了方法学和概念上的局限性。我们还批判性地讨论了扣带回皮质变化作为该疾病可能的特质或状态标志物的有效性。
