Jenike M A, Breiter H C, Baer L, Kennedy D N, Savage C R, Olivares M J, O'Sullivan R L, Shera D M, Rauch S L, Keuthen N, Rosen B R, Caviness V S, Filipek P A
Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
Arch Gen Psychiatry. 1996 Jul;53(7):625-32. doi: 10.1001/archpsyc.1996.01830070073011.
A previous pilot study of only posterior brain regions found lower white-matter volume in patients with obsessive-compulsive disorder than in normal control subjects. We used new cohorts of patients and matched normal control subjects to study whole-brain volume differences between these groups with magnetic resonance imaging-based morphometry.
Ten female patients with obsessive-compulsive disorder and 10 female control subjects, matched for handedness, age, weight, education, and verbal IQ, underwent magnetic resonance imaging with a 3-dimensional volumetric protocol. Scans were blindly normalized and segmented by means of well-characterized semiautomated intensity contour mapping and differential intensity contour algorithms. Brain structures investigated included the cerebral hemispheres, cerebral cortex, diencephalon, caudate, putamen, globus pallidus, hippocampus amygdala, third and fourth ventricles, corpus callosum, operculum, cerebellum, and brain stem. Anterior to posterior neocortical regions, including precallosum, anterior pericallosum, posterior pericallosum, and retrocallosum, with adjacent white matter were also measured. Volumes found different between groups were correlated with Yale-Brown Obsessive Compulsive Scale score and Rey-Osterieth Complex Figure Test measures.
Confirming results of our earlier pilot study and expanding the findings to the whole brain, patients with obsessive-compulsive disorder had significantly less total white matter but, in addition, significantly greater total cortex and opercular volumes. Severity of obsessive-compulsive disorder and nonverbal immediate memory correlated with opercular volume.
Replication of volumetric white-matter differences suggests a widely distributed structural brain abnormality in obsessive-compulsive disorder. Whereas determining the etiogenesis may require research at a microscopic level, understanding its functional significance can be further explored via functional neuroimaging and neuropsychological studies.
先前一项仅针对脑后部区域的初步研究发现，强迫症患者的白质体积低于正常对照受试者。我们使用新的患者队列和匹配的正常对照受试者，通过基于磁共振成像的形态学测量来研究这些组之间的全脑体积差异。
10名患有强迫症的女性患者和10名在利手、年龄、体重、教育程度和言语智商方面相匹配的女性对照受试者，接受了采用三维容积方案的磁共振成像检查。扫描图像通过特征明确的半自动强度轮廓映射和差异强度轮廓算法进行盲法标准化和分割。所研究的脑结构包括大脑半球、大脑皮质、间脑、尾状核、壳核、苍白球、海马、杏仁核、第三和第四脑室、胼胝体、岛盖、小脑和脑干。还测量了包括胼胝体前、胼胝体前部、胼胝体后部和胼胝体后部在内的前后新皮质区域及其相邻白质。组间发现不同的体积与耶鲁-布朗强迫症量表评分和雷-奥斯特里思复杂图形测试指标相关。
证实了我们早期初步研究的结果，并将研究结果扩展至全脑，强迫症患者的总白质明显较少，但此外，总皮质和岛盖体积明显更大。强迫症的严重程度和非言语即时记忆与岛盖体积相关。
白质体积差异的重复研究表明，强迫症存在广泛分布的脑结构异常。虽然确定其病因可能需要在微观层面进行研究，但可通过功能神经影像学和神经心理学研究进一步探索其功能意义。
