Department of Neuropsychiatry, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan.
Neuroimage. 2014 Jan 15;85 Pt 1:498-507. doi: 10.1016/j.neuroimage.2013.05.126. Epub 2013 Jun 10.
A serious problem in psychiatric practice is the lack of specific, objective biomarker-based assessments to guide diagnosis and treatment. The use of such biomarkers could assist clinicians in establishing differential diagnosis, which may improve specific individualised treatment. This multi-site study sought to develop a clinically suitable neuroimaging-guided diagnostic support system for differential diagnosis at the single-subject level among multiple psychiatric disorders with depressive symptoms using near-infrared spectroscopy, which is a compact and portable neuroimaging method. We conducted a multi-site, case-control replication study using two cohorts, which included seven hospitals in Japan. The study included 673 patients (women/men: 315/358) with psychiatric disorders (major depressive disorder, bipolar disorder, or schizophrenia) who manifested depressive symptoms, and 1007 healthy volunteers (530/477). We measured the accuracy of the single-subject classification in differential diagnosis among major psychiatric disorders, based on spatiotemporal characteristics of fronto-temporal cortical haemodynamic response patterns induced by a brief (<3 min) verbal fluency task. Data from the initial site were used to determine an optimal threshold, based on receiver-operator characteristics analysis, and to generate the simplest and most significant algorithm, which was validated using data from the remaining six sites. The frontal haemodynamic patterns detected by the near-infrared spectroscopy method accurately distinguished between patients with major depressive disorder (74.6%) and those with the two other disorders (85.5%; bipolar disorder or schizophrenia) that presented with depressive symptoms. These results suggest that neuroimaging-guided differential diagnosis of major psychiatric disorders developed using the near-infrared spectroscopy method can be a promising biomarker that should aid in personalised care in real clinical settings. Potential confounding effects of clinical (e.g., age, sex) and systemic (e.g., autonomic nervous system indices) variables on brain signals will need to be clarified to improve classification accuracy.
在精神科实践中，一个严重的问题是缺乏基于特定、客观生物标志物的评估来指导诊断和治疗。使用这些生物标志物可以帮助临床医生进行鉴别诊断，这可能会改善特定的个体化治疗。这项多中心研究旨在开发一种临床适用的神经影像引导的诊断支持系统，用于使用近红外光谱对具有抑郁症状的多种精神障碍进行个体水平的鉴别诊断，近红外光谱是一种紧凑且便携的神经影像方法。我们进行了一项多中心病例对照复制研究，使用了两个队列，包括日本的七家医院。该研究纳入了 673 名（女性/男性：315/358）患有表现出抑郁症状的精神障碍（重性抑郁障碍、双相情感障碍或精神分裂症）的患者，以及 1007 名健康志愿者（530/477）。我们基于短暂（<3 分钟）言语流畅性任务引起的额颞皮质血液动力学反应模式的时空特征，测量了在主要精神障碍中进行个体水平鉴别诊断的准确率。基于受试者工作特征分析，使用初始站点的数据确定最佳阈值，并生成最简单且最显著的算法，然后使用其余六个站点的数据进行验证。近红外光谱方法检测到的额部血液动力学模式准确地区分了重性抑郁障碍患者（74.6%）和另外两种具有抑郁症状的精神障碍患者（双相情感障碍或精神分裂症）（85.5%）。这些结果表明，使用近红外光谱方法开发的神经影像引导的主要精神障碍鉴别诊断可以作为一种有前途的生物标志物，有助于在实际临床环境中进行个性化护理。需要阐明临床（如年龄、性别）和系统（如自主神经系统指标）变量对脑信号的潜在混杂影响，以提高分类准确率。
