Personalized target selection for TMS therapy using functional vs. structural connectivity MRI

项目摘要 标题：使用功能与结构连接MRI进行TMS治疗的个性化靶点选择 经颅磁刺激（TMS）是FDA批准的治疗重度抑郁症（MDD）的方法。 估计缓解率约为30%，与其他抗抑郁治疗相似，但仍不理想。 反应的变化性的一个关键原因是缺乏一个个性化的方法来识别皮层 为每位患者制定治疗目标。一个建议的策略是使用功能连接MRI来识别 与MDD相关的功能网络拓扑。在这个项目中，我们提出了一种新颖的策略，以个性化 通过使用扩散MRI（dMRI）识别TMS靶点，以识别连接的白色物质束 MDD影响的两个关键节点：左前额叶皮层（PFC）和膝下扣带回（SGC）。我们将 研究了来自人类连接组项目（HCP）的500名受试者和20名接受治疗的MDD患者 在TMS。我们将使用最先进的功能连接和扩散MRI数据和分析。我们的目标是 第一次量化和比较这些方法识别TMS皮层靶点的可靠性 疗法此外，我们将通过回顾性分析dMRI引导的TMS的临床疗效 治疗反应与刺激TMS靶点位置之间的关系 dMRI节点。最后，我们将使用复杂的dMRI指标来评估白色物质微观结构的变化 经颅磁刺激诱导的疼痛，以及它们与临床疗效的关系（因此定义了作用的解剖学机制 治疗目标）。该项目的结果将支持未来的前瞻性试验，旨在确认目标 在MDD和其他疾病中使用个体化dMRI引导的TMS进行参与和治疗反应 神经精神疾病

Project Summary Title: Personalized target selection for TMS therapy using functional vs. structural connectivity MRI Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for major depressive disorder (MDD). Remission rates are estimated to be around 30%, similar to other antidepressant therapies yet still suboptimal. A key reason for the variability in response is the lack of an individualized approach that identifies the cortical therapeutic target for each patient. A proposed strategy is to use functional connectivity MRI to identify the topography of functional networks relevant to MDD. In this project, we propose a novel strategy to personalized identification of TMS targets by using diffusion MRI (dMRI) to identify the white matter bundles that connect two critical nodes affected by MDD: the left prefrontal cortex (PFC) and the subgenual cingulate (SGC). We will study 500 subjects from the Human Connectome Project (HCP) and 20 patients with MDD who were treated with TMS. We will use state-of-the-art functional connectivity and diffusion MRI data and analyses. Our goal is to quantify and compare, for the first time, the reliability of these methods to identify cortical targets for TMS therapy. In addition we will study the clinical efficacy of dMRI-guided TMS by retrospectively analyzing the relationship between therapeutic response and location of the stimulated TMS target in relation to the optimal dMRI node. Last, we will use sophisticated dMRI metrics to assess the changes in white matter microstructure induced by TMS and how they relate to clinical efficacy (therefore defining anatomical mechanisms of action and therapeutic targets). Results from this project will support future prospective trials aiming to confirm target engagement and therapeutic response using individualized dMRI-guided TMS in MDD and other neuropsychiatric conditions.