Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France.
Eur J Nucl Med Mol Imaging. 2011 Sep;38(9):1715-22. doi: 10.1007/s00259-011-1850-9. Epub 2011 Jun 7.
The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression.
Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of (99m)Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p < 0.001, uncorrected).
Of the patients, 18 (54.5%) were responders to rTMS and 15 were non-responders (45.5%). There were no statistically significant differences in demographic and clinical characteristics (p > 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively.
This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features.
本研究旨在确定全脑基于体素的局部脑血流（rCBF）对药物难治性抑郁症患者重复经颅磁刺激（rTMS）反应的预测价值。
33 名符合 DSM-IV 标准的右利手患者被纳入 rTMS 治疗前。rTMS 反应定义为贝克抑郁量表（BDI）基线评分至少降低 50%。通过比较 rTMS 反应者和非反应者在体素水平上的（99m）Tc-乙基半胱氨酸二聚体（ECD）单光子发射计算机断层扫描（SPECT），使用统计参数映射（SPM）（p < 0.001，未校正）研究治疗前 SPECT 对 rTMS 反应的预测价值。
在这些患者中，18 名（54.5%）对 rTMS 有反应，15 名无反应（45.5%）。两组在人口统计学和临床特征方面无统计学差异（p > 0.10）。与反应者相比，非反应者在左侧内侧和双侧额上回（BA10）、左侧钩回/海马旁皮质（BA20/BA35）和右侧丘脑显示出明显的灌注不足（p < 0.001，未校正）。SPECT 簇联合预测 rTMS 反应的曲线下面积为 0.89（p < 0.001）。联合簇预测 rTMS 反应的敏感性、特异性、阳性预测值和阴性预测值分别为 94%、73%、81%和 92%。
本研究表明，在药物难治性抑郁症中，特定脑区的 rCBF 预处理是同质人口统计学/临床特征患者对 rTMS 反应的有力预测因子。
