自由水扩散磁共振成像可区分治疗抵抗性抑郁症中的自杀意念与自杀未遂。
Free-Water Diffusion Magnetic Resonance Imaging Differentiates Suicidal Ideation From Suicide Attempt in Treatment-Resistant Depression.
机构信息
University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Apr;8(4):471-481. doi: 10.1016/j.bpsc.2022.12.007. Epub 2022 Dec 20.
BACKGROUND
Suicide attempt is highly prevalent in treatment-resistant depression (TRD); however, the neurobiological profile of suicidal ideation versus suicide attempt is unclear. Neuroimaging methods including diffusion magnetic resonance imaging-based free-water imaging may identify neural correlates underlying suicidal ideation and attempts in individuals with TRD.
METHODS
Diffusion magnetic resonance imaging data were obtained from 64 male and female participants (mean age 44.5 ± 14.2 years), including 39 patients with TRD (n = 21 and lifetime history of suicidal ideation but no attempts [SI group]; n = 18 with lifetime history of suicide attempt [SA group]), and 25 age- and sex-matched healthy control participants. Depression and suicidal ideation severity were examined using clinician-rated and self-report measures. Whole-brain neuroimaging analysis was conducted using tract-based spatial statistics via FSL to identify differences in white matter microstructure in the SI versus SA groups and in patients versus control participants.
RESULTS
Free-water imaging revealed elevated axial diffusivity and extracellular free water in fronto-thalamo-limbic white matter tracts of the SA group compared with the SI group. In a separate comparison, patients with TRD had widespread reductions in fractional anisotropy and axial diffusivity, as well as elevated radial diffusivity compared with control participants (thresholded p < .05, familywise error corrected).
CONCLUSIONS
A unique neural signature consisting of elevated axial diffusivity and free water was identified in patients with TRD and suicide attempt history. Findings of reduced fractional anisotropy, axial diffusivity, and elevated radial diffusivity in patients versus control participants are consistent with previously published studies. Multimodal and prospective investigations are recommended to better understand biological correlates of suicide attempt in TRD.
背景
自杀未遂在治疗抵抗性抑郁症（TRD）中非常普遍；然而，自杀意念与自杀未遂的神经生物学特征尚不清楚。神经影像学方法，包括基于弥散磁共振成像的自由水成像，可能会确定 TRD 个体中自杀意念和尝试背后的神经相关性。
方法
从 64 名男性和女性参与者（平均年龄 44.5±14.2 岁）中获得弥散磁共振成像数据，包括 39 名 TRD 患者（n=21，有自杀意念但无尝试史[SI 组]；n=18，有自杀尝试史[SA 组]）和 25 名年龄和性别匹配的健康对照参与者。使用临床医生评定和自我报告的测量方法评估抑郁和自杀意念严重程度。通过 FSL 的基于束的空间统计学进行全脑神经影像学分析，以确定 SI 组与 SA 组以及患者与对照参与者之间白质微观结构的差异。
结果
自由水成像显示 SA 组额-丘脑-边缘白质束中轴突弥散率和细胞外自由水升高。在另一项比较中，与对照参与者相比，TRD 患者的各向异性分数和轴突弥散率普遍降低，以及径向弥散率升高（阈值 p<.05，经家族性错误校正）。
结论
在 TRD 伴自杀尝试史的患者中，确定了一个由轴突弥散率升高和自由水组成的独特神经特征。与之前发表的研究一致，患者与对照参与者相比，各向异性分数、轴突弥散率降低，以及径向弥散率升高。建议进行多模态和前瞻性研究，以更好地理解 TRD 中自杀尝试的生物学相关性。
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