Lui Su, Parkes Laura M, Huang Xiaoqi, Zou Ke, Chan Raymond C K, Yang Hong, Zou Ling, Li Dongming, Tang Hehan, Zhang Tijiang, Li Xiuli, Wei Yi, Chen Long, Sun Xueli, Kemp Graham J, Gong Qi-Yong
Department of Radiology, Huaxi MR Research Center, State Key Laboratory of Biotherapy, West China Hospital, West China School of Clinical Medicine, Guo Xuexiang 37, Chengdu Sichuan 610041, China.
Radiology. 2009 May;251(2):476-84. doi: 10.1148/radiol.2512081548.
To assess focal cerebral perfusion in patients with refractory depressive disorder (RDD), patients with nonrefractory depressive disorder (NDD), and healthy control subjects by using arterial spin-labeling (ASL) magnetic resonance (MR) imaging.
This study was approved by the local ethical committee, and written informed consent was obtained from all participants. Twenty-four patients with RDD, 37 patients with NDD, and 42 healthy control subjects were included. From February 2006 to July 2007, all participants were imaged with a 3-T MR system. ASL and echo-planar images were subtracted and averaged to give perfusion-weighted images. Voxel-based analysis was performed. Region-of-interest analysis was applied to the bilateral hippocampi, thalami, and lentiform nuclei.
Patients with NDD showed reduced perfusion in the left prefrontal cortex versus control subjects and increased perfusion mainly in the limbic-striatal areas (P < .05). In contrast, patients with RDD had decreased perfusion predominantly in the bilateral frontal and bilateral thalamic regions (P < .05). Compared with patients with RDD, patients with NDD showed higher perfusion mainly in the limbic-striatal areas (P < .05). In region-of-interest analysis, the NDD group showed higher regional cerebral blood flow than both RDD and control groups in the left hippocampus (P = .045), right hippocampus (P = .001), and right lentiform nucleus (P = .049).
This study revealed alterations of regional perfusion in the brains of patients with RDD that differed from those in patients with NDD. These results are consistent with the concept that RDD is associated with decreased activity of the bilateral prefrontal areas; and NDD, with decreased activity of left frontal areas in conjunction with overactivity of the bilateral limbic system.
通过动脉自旋标记（ASL）磁共振（MR）成像评估难治性抑郁症（RDD）患者、非难治性抑郁症（NDD）患者及健康对照者的局灶性脑灌注情况。
本研究经当地伦理委员会批准，所有参与者均签署了书面知情同意书。纳入24例RDD患者、37例NDD患者和42例健康对照者。2006年2月至2007年7月，所有参与者均采用3-T MR系统进行成像。将ASL图像与回波平面图像相减并平均，以获得灌注加权图像。进行基于体素的分析。对双侧海马、丘脑和豆状核进行感兴趣区分析。
与对照者相比，NDD患者左侧前额叶皮质灌注减少，主要在边缘-纹状体区域灌注增加（P <.05）。相比之下，RDD患者主要在双侧额叶和双侧丘脑区域灌注减少（P <.05）。与RDD患者相比，NDD患者主要在边缘-纹状体区域灌注较高（P <.05）。在感兴趣区分析中，NDD组在左侧海马（P =.045）、右侧海马（P =.001）和右侧豆状核（P =.049）的局部脑血流量高于RDD组和对照组。
本研究揭示了RDD患者脑内区域灌注改变与NDD患者不同。这些结果与以下概念一致，即RDD与双侧前额叶区域活动减少有关；而NDD与左侧额叶区域活动减少及双侧边缘系统活动过度有关。
