Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
J Psychiatr Res. 2023 Jul;163:337-349. doi: 10.1016/j.jpsychires.2023.05.059. Epub 2023 May 22.
Anorexia nervosa (AN) entails many uncertainties regarding the clinical outcome, due to large heterogeneity in the disease course. AN is associated with global decrease in brain volumes and altered brain functioning during acute illness. However, it is unclear whether structural and functional brain alterations can predict clinical outcome. We aimed to systematically review the predictive value of volumetric and functional brain outcome measures of structural and functional brain magnetic resonance imaging (MRI) on the disease course of AN. Four databases (Embase, Medline, Psycinfo, and Cochrane Central Register) were systematically searched. A total of 15 studies (structural MRI: n = 6, functional MRI: n = 9) were reviewed. In total 464 unique AN patients, and 328 controls were included. Follow-up time ranged between 1 and 43 months. Structural neuroimaging studies showed that lower brain volumes of the cerebellum, subcortical grey matter, and cortical white matter at admission predicted a worse clinical outcome. A smaller increase of the anterior cingulate cortex volume in the early phase of the disease predicted a worse clinical outcome. Lower overall gyrification, and a higher clustering coefficient predicted a worse clinical outcome. Functional MRI studies showed that frontal, parietal and temporal activity during task-based algorithms predicted follow-up body mass index, although results were bidirectional possibly due to the large heterogeneity in methodological approaches. Neuroimaging measures may predict the clinical outcome of AN. However, there is a lack of replication studies. Future studies are needed to validate the prognostic utility of neuroimaging measures in AN patients, and should harmonize demographic, clinical and neuroimaging features in order to enhance comparability.
神经性厌食症（AN）由于疾病过程中的高度异质性，其临床结果存在许多不确定性。AN 与大脑体积的全球减少和急性疾病期间大脑功能的改变有关。然而，目前尚不清楚结构和功能脑改变是否可以预测临床结果。我们旨在系统地回顾结构和功能磁共振成像（MRI）的容积和功能脑测量对 AN 疾病过程的预测价值。系统地搜索了四个数据库（Embase、Medline、Psycinfo 和 Cochrane Central Register）。共审查了 15 项研究（结构 MRI：n=6，功能 MRI：n=9）。共有 464 名独特的 AN 患者和 328 名对照者纳入研究。随访时间为 1 至 43 个月。结构神经影像学研究表明，入院时小脑、皮质下灰质和皮质白质的脑体积较低，预测临床结局较差。疾病早期前扣带回皮质体积增加较小，预测临床结局较差。整体脑回化程度较低，聚类系数较高，预测临床结局较差。功能 MRI 研究表明，基于任务的算法中的额叶、顶叶和颞叶活动预测了随访时的体重指数，尽管由于方法学方法的高度异质性，结果可能是双向的。神经影像学测量可能预测 AN 的临床结果。然而，缺乏复制研究。未来的研究需要验证神经影像学测量在 AN 患者中的预后效用，并且应该协调人口统计学、临床和神经影像学特征，以增强可比性。
