Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.
Neuroimage Clin. 2021;30:102640. doi: 10.1016/j.nicl.2021.102640. Epub 2021 Mar 22.
Deep brain stimulation (DBS) is a new treatment option for patients with therapy-resistant obsessive-compulsive disorder (OCD). Approximately 60% of patients benefit from DBS, which might be improved if a biomarker could identify patients who are likely to respond. Therefore, we evaluated the use of preoperative structural magnetic resonance imaging (MRI) in predicting treatment outcome for OCD patients on the group- and individual-level.
In this retrospective study, we analyzed preoperative MRI data of a large cohort of patients who received DBS for OCD (n = 57). We used voxel-based morphometry to investigate whether grey matter (GM) or white matter (WM) volume surrounding the DBS electrode (nucleus accumbens (NAc), anterior thalamic radiation), and whole-brain GM/WM volume were associated with OCD severity and response status at 12-month follow-up. In addition, we performed machine learning analyses to predict treatment outcome at an individual-level and evaluated its performance using cross-validation.
Larger preoperative left NAc volume was associated with lower OCD severity at 12-month follow-up (p < 0.05). None of the individual-level regression/classification analyses exceeded chance-level performance.
These results provide evidence that patients with larger NAc volumes show a better response to DBS, indicating that DBS success is partly determined by individual differences in brain anatomy. However, the results also indicate that structural MRI data alone does not provide sufficient information to guide clinical decision making at an individual level yet.
深部脑刺激（DBS）是一种治疗难治性强迫症（OCD）的新方法。大约 60%的患者从 DBS 中获益，如果有一种生物标志物可以识别出可能有反应的患者，那么效果可能会更好。因此，我们评估了术前结构磁共振成像（MRI）在预测 OCD 患者群体和个体治疗结果中的作用。
在这项回顾性研究中，我们分析了接受 DBS 治疗 OCD 的大样本患者（n=57）的术前 MRI 数据。我们使用基于体素的形态测量学来研究 DBS 电极（伏隔核（NAc）、前丘脑辐射）周围的灰质（GM）或白质（WM）体积以及全脑 GM/WM 体积是否与 OCD 严重程度和 12 个月随访时的反应状态相关。此外，我们进行了机器学习分析，以预测个体水平的治疗结果，并使用交叉验证评估其性能。
术前左侧 NAc 体积越大，12 个月随访时 OCD 严重程度越低（p<0.05）。个体水平的回归/分类分析均未超过机会水平。
这些结果提供了证据表明，NAc 体积较大的患者对 DBS 的反应更好，这表明 DBS 的成功部分取决于大脑解剖结构的个体差异。然而，结果也表明，结构 MRI 数据本身并不能提供足够的信息来指导个体水平的临床决策。
