Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review.
Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review.
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DOI：
10.1080/09540260902962198
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Krishnan KR
中科院分区：
文献类型：
--
作者：
Beyer JL;Young R;Kuchibhatla M;Krishnan KR
磁共振成像（MRI）扫描中的皮质和皮质下高信号被认为代表脑组织缺血性损伤的区域。研究人员已经关注这些病变在精神疾病（包括双相情感障碍）中可能发挥的作用。1997年，提出的“血管躁狂症”诊断建议不仅利用中风的存在，而且在其诊断标准中还利用融合高信号。本研究旨在使用荟萃分析技术调查高信号与双相情感障碍的相关性，并评价文献的现状。使用PubMed和MEDLINE数据库，我们对双相情感障碍和对照组或其他精神疾病受试者的高信号研究进行了系统的文献检索。我们确定了44篇出版物，其中35项研究被纳入综述，27项被选择进行荟萃分析。通过比值比和置信区间估计患病率的汇总统计量。使用Q-统计量检验研究间结果的异质性。荟萃分析发现，与对照组相比，双相情感障碍受试者高信号的比值比为2.5（95% CI 1.9，3.3）;然而，研究之间存在显著异质性（Q统计=32; p =0.04）。这一发现在青少年和儿童中最为突出，比值比为5.7（95% CI 2.3，13.7）。深白色物质高信号（比值比3.2; 95% CI 2.2，4.5）和皮质下灰质高信号（比值比2.7; 95% CI 1.3，2.9）与双相情感障碍患者的相关性更强。双相情感障碍受试者和对照者之间的血管周围高信号无差异（比值比1.3; 95% CI 0.8，1.9）。虽然双相情感障碍患者的高信号在数值上更高，但荟萃分析并未显示双相情感障碍患者与单相抑郁症患者（OR 1.6; 95% CI 0.9，2.7）或精神分裂症患者（OR 1.5; 95% CI 0.9，2.7）之间存在任何显著差异。这项荟萃分析继续支持双相情感障碍与高信号的相关性，特别是在深层白色物质和皮质下灰质中。它还强调了儿童和青少年双相情感障碍发病率的增加。然而，高信号并不是双相情感障碍所特有的，但在单相抑郁症和精神分裂症中的发生率相似。因此，高信号在双相情感障碍的发病机制、病理生理学和治疗中的作用仍不清楚。需要进一步的研究，以减少样本和MRI技术的异质性，评估高信号的大小和位置，以及对治疗反应的影响。与较新的成像技术，如扩散张量成像（DTI）的协调可能特别有助于了解这些病变的病理。
Cortical and subcortical hyperintensities in magnetic resonance imaging (MRI) scans are thought to represent areas of ischemic damage to brain tissue. Researchers have focused on the possible role these lesions may have in psychiatric disorders, including bipolar disorder. In 1997, the proposed ‘vascular mania’ diagnosis suggested utilizing not only the presence of strokes, but also confluent hyperintensities in its diagnostic criteria. This study was conducted to use meta-analytic techniques to investigate the association of hyperintensities and bipolar illness and to evaluate the current state of the literature. Using the PubMed and MEDLINE databases, we conducted a systematic literature search of studies investigating hyperintensities in subjects with bipolar disorder and controls or other psychiatric illnesses. We identified 44 publications from which 35 studies were included for review and 27 were selected for meta-analysis. Summary statistics of the prevalence were estimated through odds-ratios and confidence interval. Heterogeneity of the results across studies was tested using Q-statistics. Meta-analysis identified an odds ratio of 2.5 (95% CI 1.9, 3.3) for hyperintensities in bipolar subjects compared to controls; however, there was significant heterogeneity among the studies (Q-statistics =32; p =0.04). This finding was most prominent for adolescents and children where the odds ratio was 5.7 (95% CI 2.3, 13.7). Deep white matter hyperintensities (odd ratio 3.2; 95% CI 2.2, 4.5) and subcortical grey matter hyperintensities (odds ratio 2.7; 95% CI 1.3, 2.9) were more strongly associated with bipolar subjects. There were no differences between bipolar subjects and controls for perivascular hyperintensities (odds ratio 1.3; 95% CI 0.8, 1.9). Though hyperintensities were numerically greater in bipolar subjects, meta-analysis did not demonstrate any significant differences between bipolar subjects and unipolar depression subjects (OR 1.6; 95% CI 0.9, 2.7) nor subjects with schizophrenia (OR 1.5; 95% CI 0.9, 2.7). This meta-analysis continues to support the association of bipolar disorder and hyperintensities, especially in the deep white matter and subcortical grey matter. It also highlights the increased incidence in children and adolescence with bipolar disorder. However, hyperintensities are not specific to bipolar disorder, but appear at similar rates in unipolar depression and schizophrenia. Thus, the role of hyperintensities in the pathogenesis, pathophysiology, and treatment of bipolar disorder remains unclear. Further studies are required that are large enough to decrease the heterogeneity of the samples and MRI techniques, assess size and location of hyperintensities, and the impact on treatment response. Coordination with newer imaging techniques, such as diffusion tensor imaging (DTI) may be especially helpful in understanding the pathology of these lesions.
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DOI：
10.1097/01.jgp.0000200603.70504.d5
发表时间：
2006-07-01
影响因子：
7.2
作者：
de Asis, Jose M.;Greenwald, Blaine S.;Young, Robert C.
通讯作者：
Young, Robert C.
影响因子：
2
作者：
Böhm, D;Hoffmann, K;Bohlander, SK
通讯作者：
Bohlander, SK
DOI：
10.1097/00004583-199506000-00014
发表时间：
1995-06-01
影响因子：
13.3
作者：
BOTTERON, KN;VANNIER, MW;LEE, BCP
通讯作者：
LEE, BCP
影响因子：
3.8
作者：
Breeze, JL;Hesdorffer, DC;Renshaw, PF
通讯作者：
Renshaw, PF
影响因子：
5
作者：
BRAFFMAN, BH;ZIMMERMAN, RA;SCHLAEPFER, WW
通讯作者：
SCHLAEPFER, WW