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性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障碍(MDD)的方法。 缓解率估计在30%左右，与其他抗抑郁药物疗法相似，但仍不理想。 反应差异的一个关键原因是缺乏一种个性化的方法来识别大脑皮层 每个患者的治疗目标。建议的策略是使用功能连接性MRI来识别 与MDD相关的功能网络的拓扑图。在这个项目中，我们提出了一种新颖的个性化策略 利用弥散磁共振成像(DMRI)识别TMS靶点以识别连接的白质束 受MDD影响的两个关键节点：左侧前额叶皮质(PFC)和膝下扣带回(SGC)。我们会 研究了500名来自人类连接组项目(HCP)的受试者和20名接受治疗的MDD患者 有TMS的患者。我们将使用最先进的功能连接和扩散磁共振数据和分析。我们的目标是 首次量化和比较这些方法识别TMS皮质靶点的可靠性 心理治疗。此外，我们将通过回顾分析DMRI引导下TMS的临床疗效 治疗反应与刺激TMS靶点位置与最佳靶点的关系 DMRI节点。最后，我们将使用复杂的dmri指标来评估脑白质微结构的变化。 TMS的诱导及其与临床疗效的关系(因此定义了解剖学的作用机制 和治疗靶点)。该项目的结果将支持未来旨在确定目标的前瞻性试验 在MDD和其他疾病中使用个性化dMRI引导TMS的参与度和治疗反应 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.