White matter abnormalities in obsessive-compulsive disorder: a diffusion tensor imaging study.
White matter abnormalities in obsessive-compulsive disorder: a diffusion tensor imaging study.
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DOI：
10.1001/archpsyc.62.7.782
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发表时间：
2005-07
影响因子：
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通讯作者：
P. Szeszko;B. Ardekani;M. Ashtari;A. Malhotra;D. Robinson;R. Bilder;K. Lim
中科院分区：
文献类型：
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作者：
P. Szeszko;B. Ardekani;M. Ashtari;A. Malhotra;D. Robinson;R. Bilder;K. Lim
强迫症（OCD）的几种神经生物学模型都认为扣带回前部功能障碍起主要作用。功能和结构的神经影像学研究暗示前扣带灰质异常的病理生理学强迫症，但一直很少有调查的前扣带白色物质在这种疾病。目的通过弥散张量成像（DWI）研究，验证强迫症患者扣带回前部白色物质微结构异常的假设。其他分析检查了整个大脑中白色物质完整性的组间差异。设计、设置和参与者：15例符合DSM-IV诊断的强迫症患者和15例年龄、性别和利手相匹配的健康志愿者进行了弥散张量成像和结构磁共振成像检查。分数各向异性（FA），一个强大的水自扩散的体素内测量，比较组间的前扣带回白色物质的标准化后，在Talairach空间的基础上逐体素。主要观察指标：症状严重程度临床评分（即Yale-Brown强迫量表）和FA。结果与健康志愿者相比，患者双侧扣带回前部白色物质3个区域的FA值均显著降低。对大脑其余部分白色物质进行的其他分析显示，双侧顶叶区域（缘上回）、右侧扣带回后部和左侧枕叶（舌回）FA较低。与健康志愿者相比，在患者中未观察到FA显著升高的区域。顶叶区FA值越低，Yale-Brown强迫量表得分越高。结论：这些初步发现提供了一个异常的证据，涉及前扣带回白色物质在强迫症的发病机制，并与神经生物学模型，解释缺陷的连接在前扣带回基底神经节-丘脑皮质回路。其他脑区的白色物质异常也可能与强迫症的神经生物学有关。
CONTEXT Several neurobiological models of obsessive-compulsive disorder (OCD) posit a primary role for dysfunction of the anterior cingulate gyrus. Both functional and structural neuroimaging studies have implicated anterior cingulate gray matter abnormalities in the pathophysiology of OCD, but there has been little investigation of the anterior cingulate white matter in this disorder. OBJECTIVE To test the hypothesis that patients with OCD have abnormal white matter microstructure in the anterior cingulate gyrus compared with healthy volunteers as inferred from diffusion tensor imaging. Additional analyses examined group differences in white matter integrity across the entire brain. DESIGN, SETTING, AND PARTICIPANTS Fifteen patients with a DSM-IV diagnosis of OCD and 15 healthy volunteers matched for age, sex, and handedness underwent diffusion tensor imaging and structural magnetic resonance imaging examinations. Fractional anisotropy (FA), a robust intravoxel measure of water self-diffusion, was compared between groups on a voxel-by-voxel basis in the anterior cingulate white matter after standardization in Talairach space. MAIN OUTCOME MEASURES Clinical ratings of symptom severity (ie, Yale-Brown Obsessive-Compulsive Scale) and FA. RESULTS Compared with healthy volunteers, patients demonstrated significantly lower FA bilaterally in 3 areas of the anterior cingulate gyrus white matter. Additional analyses conducted across the rest of the brain white matter revealed lower FA bilaterally in the parietal region (supramarginal gyri), right posterior cingulate gyrus, and left occipital lobe (lingual gyrus). No areas of significantly higher FA were observed in patients compared with healthy volunteers. Lower FA in the parietal region correlated significantly with higher Yale-Brown Obsessive-Compulsive Scale scores. CONCLUSIONS These preliminary findings provide evidence of an abnormality that involves the anterior cingulate white matter in the pathogenesis of OCD and are consistent with neurobiological models that posit a defect in connectivity in the anterior cingulate basal ganglia-thalamocortical circuit. White matter abnormalities in other brain regions may also be implicated in the neurobiology of OCD.