Riva-Posse Patricio, Choi Ki Sueng, Holtzheimer Paul E, McIntyre Cameron C, Gross Robert E, Chaturvedi Ashutosh, Crowell Andrea L, Garlow Steven J, Rajendra Justin K, Mayberg Helen S
Department of Psychiatry and Behavioral Sciences, Emory University.
Department of Psychiatry and Behavioral Sciences, Emory University; Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia; Biomedical Imaging Technology Center, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
Biol Psychiatry. 2014 Dec 15;76(12):963-9. doi: 10.1016/j.biopsych.2014.03.029. Epub 2014 Apr 13.
Subcallosal cingulate white matter (SCC) deep brain stimulation (DBS) is an evolving investigational treatment for depression. Mechanisms of action are hypothesized to involve modulation of activity within a structurally defined network of brain regions involved in mood regulation. Diffusion tensor imaging was used to model white matter connections within this network to identify those critical for successful antidepressant response.
Preoperative high-resolution magnetic resonance imaging data, including diffusion tensor imaging, were acquired in 16 patients with treatment-resistant depression, who then received SCC DBS. Computerized tomography was used postoperatively to locate DBS contacts. The activation volume around the contacts used for chronic stimulation was modeled for each patient retrospectively. Probabilistic tractography was used to delineate the white matter tracts traveling through each activation volume. Patient-specific tract maps were calculated using whole-brain analysis. Clinical evaluations of therapeutic outcome from SCC DBS were defined at 6 months and 2 years.
Whole-brain activation volume tractography demonstrated that all DBS responders at 6 months (n = 6) and 2 years (n = 12) shared bilateral pathways from their activation volumes to 1) medial frontal cortex via forceps minor and uncinate fasciculus; 2) rostral and dorsal cingulate cortex via the cingulum bundle; and 3) subcortical nuclei. Nonresponders did not consistently show these connections. Specific anatomical coordinates of the active contacts did not discriminate responders from nonresponders.
Patient-specific activation volume tractography modeling may identify critical tracts that mediate SCC DBS antidepressant response. This suggests a novel method for patient-specific target and stimulation parameter selection.
扣带回下白质（SCC）深部脑刺激（DBS）是一种不断发展的抑郁症研究性治疗方法。其作用机制据推测涉及对参与情绪调节的大脑区域结构定义网络内活动的调节。扩散张量成像被用于对该网络内的白质连接进行建模，以识别那些对成功的抗抑郁反应至关重要的连接。
对16例难治性抑郁症患者术前采集了包括扩散张量成像在内的高分辨率磁共振成像数据，这些患者随后接受了SCC DBS治疗。术后使用计算机断层扫描来定位DBS电极触点。对每位患者回顾性地建模用于慢性刺激的电极触点周围的激活体积。使用概率性纤维束成像来描绘穿过每个激活体积的白质纤维束。使用全脑分析计算患者特异性纤维束图。SCC DBS治疗效果的临床评估在6个月和2年时进行定义。
全脑激活体积纤维束成像显示，在6个月时（n = 6）和2年时（n = 12）所有DBS反应者从其激活体积共享双侧通路至1）通过小钳和钩束至内侧额叶皮质；2）通过扣带束至喙侧和背侧扣带回皮质；以及3）至皮质下核团。无反应者未一致显示出这些连接。活跃电极触点的特定解剖坐标并不能区分反应者和无反应者。
患者特异性激活体积纤维束成像建模可能识别介导SCC DBS抗抑郁反应的关键纤维束。这提示了一种用于患者特异性靶点和刺激参数选择的新方法。
