Hyperintensities on T2-weighted images in the basal ganglia of patients with major depression: cerebral perfusion and clinical implications.

White matter hyperintensities on T2-weighted images (WMH T2-WI) are prevalent in depressed, particularly elderly, patients. In an earlier study we used structural magnetic resonance imaging (MRI) to study 37 depressed and 27 healthy control subjects to show that prevalence of WMH T2-WI is higher in depressed patients and that severity of depression and cognitive impairment is associated with presence of WMH T2-WI in basal ganglia. The occurrence of WMH T2-WI in depression may also be associated with cerebrovascular deficiency, although this association has not been adequately studied. We therefore performed single photon emission computed tomography (SPECT) with Technetium-99m hexamethylpropyleneamineoxime (Tc-99m HMPAO) as tracer in this same sample to seek an association between presence/location of WMH T2-WI and cerebral perfusion deficits. In addition, we examined the relationship between presence/location of WMH T2-WI and treatment response. We found that severely depressed, cognitively compromised patients with WMH T2-WI in the basal ganglia display more profuse cerebral perfusion deficits than less depressed patients with WMH T2-WI in other regions or with no WMH T2-WI but are not less responsive to antidepressant treatment. WMH T2-WI in depression are associated with cerebral perfusion deficits, although not necessarily located in the same regions as the MRI findings. Clinical symptoms are largely reversible even in depressed patients with WMH T2-WI in basal ganglia.