Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA.
Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA.
J Affect Disord. 2018 Feb;227:498-505. doi: 10.1016/j.jad.2017.11.043. Epub 2017 Nov 13.
Bipolar Disorder (BD) cannot be reliably distinguished from Major Depressive Disorder (MDD) until the first manic or hypomanic episode. Consequently, many patients with BD are treated with antidepressants without mood stabilizers, a strategy that is often ineffective and carries a risk of inducing a manic episode. We previously reported reduced cortical thickness in right precuneus, right caudal middle-frontal cortex and left inferior parietal cortex in BD compared with MDD.
This study extends our previous work by performing individual level classification of BD or MDD in an expanded, currently unmedicated, cohort using gray matter volume (GMV) based on Magnetic Resonance Imaging and a Support Vector Machine. All patients were in a Major Depressive Episode and a leave-two-out analysis was performed.
Nineteen out of 26 BD subjects and 20 out of 26 MDD subjects were correctly identified, for a combined accuracy of 75%. The three brain regions contributing to the classification were higher GMV in bilateral supramarginal gyrus and occipital cortex indicating MDD, and higher GMV in right dorsolateral prefrontal cortex indicating BD.
This analysis included scans performed with two different headcoils and scan sequences, which limited the interpretability of results in an independent cohort analysis.
Our results add to previously published data which suggest that regional gray matter volume should be investigated further as a clinical diagnostic tool to predict BD before the appearance of a manic or hypomanic episode.
在首次躁狂或轻躁狂发作之前，双相情感障碍（BD）无法与重度抑郁症（MDD）可靠地区分。因此，许多 BD 患者在没有情绪稳定剂的情况下接受抗抑郁药治疗，这种策略往往无效，并存在诱发躁狂发作的风险。我们之前的报告显示，与 MDD 相比，BD 患者右侧楔前叶、右侧中额后回和左侧下顶叶皮质的皮质厚度减少。
本研究通过使用基于磁共振成像和支持向量机的灰质体积（GMV）对目前未用药的扩展队列中的 BD 或 MDD 进行个体水平分类，扩展了我们之前的工作。所有患者均处于重度抑郁发作期，并进行了留二法分析。
26 名 BD 受试者中有 19 名和 26 名 MDD 受试者中有 20 名被正确识别，总体准确率为 75%。对分类有贡献的三个脑区是双侧缘上回和枕叶皮质的 GMV 较高，表明为 MDD，而右侧背外侧前额叶皮质的 GMV 较高，表明为 BD。
该分析包括使用两个不同的头部线圈和扫描序列进行的扫描，这限制了在独立队列分析中对结果的解释。
我们的结果增加了之前发表的数据，这些数据表明，区域灰质体积应进一步作为预测躁狂或轻躁狂发作前 BD 的临床诊断工具进行研究。
