【作者】 孙军；

【导师】 冯晓源； 刘含秋； 黎元； 汤伟军；

【作者基本信息】 复旦大学 ， 影像医学与核医学， 2008， 博士

【摘要】 第一部分首发抑郁症患者基于体素的形态学MRI研究目的:探讨首发抑郁症患者基于体素的全脑形态改变特点。方法:采用3.0T磁共振,研究32例抑郁症患者及32例性别、年龄相匹配的正常志愿者。运用SPM2分析软件,采用基于体素的形态学方法,进行全脑比较分析。结果:抑郁症患者右侧海马、右侧杏仁核及右侧枕中回体积较正常对照组缩小(P＜0.05,FDR-corrected)。结论:首发抑郁症患者右侧海马、右侧杏仁核及右侧枕中回体积有明显缩小倾向。第二部分首发抑郁症患者治疗前后基于体素的DTI研究目的:应用磁共振弥散张量成像(DTI)技术,探讨首发抑郁症患者的治疗前后脑白质异常的变化特点。方法:采用3.0T磁共振,对13例首发抑郁症患者(分别于治疗前及抗抑郁药物治疗8周后)和14例性别、年龄相匹配的正常志愿者进行DTI检查。运用SPM2分析软件,采用基于体素的分析方法,比较全脑FA值的差异及变化。结果:首发抑郁症患者的右侧胼胝体膝部、内囊膝部、右侧下纵束所属部分区域FA值明显低于正常对照组(P＜0.001 corrected),经过药物治疗症状缓解后,FA值明显恢复(P＜0.001 corrected)。结论:治疗有效的首发抑郁症患者脑白质微观的病理改变是可逆的;DTI可以动态观察抑郁症患者脑白质微观的病理改变。第三部分首发抑郁症患者治疗前后悲伤及高兴体验的fMRI研究目的:应用功能磁共振技术,探讨首发抑郁症患者治疗前后体验悲伤及高兴面部表情的脑功能区变化特点。方法:采用3.0T磁共振,对13例首发抑郁症患者(分别于治疗前及抗抑郁药物治疗8周后)和14例性别、年龄相匹配的正常志愿者进行fMRI检查。运用SPM2分析软件,比较悲伤及高兴表情(与中性表情对照)体验的脑功能区变化。结果:悲伤体验时,治疗前患者组扣带回前部皮层活动性较正常人增高(P＜0.001,uncorrected),治疗后明显恢复(P＜0.001,uncorrected);高兴体验时,治疗前患者组左侧MDD的额上、中回背外侧皮层活动性较正常人减低(P＜0.001,uncorrected),经过治疗后明显恢复(P＜0.001,uncorrected)。结论:悲伤及高兴体验的fMRI是一项用来动态评价抑郁症患者情感障碍的重要手段,可以作为一项客观评价抗抑郁药物疗效的重要生物学指标。第四部分首发抑郁症患者治疗前后的静息态fMRI研究目的:应用低频波幅(ALFF)技术,探讨首发抑郁症患者治疗前后静息态脑功能的变化特点。方法:采用3.0T磁共振,对13例首发抑郁症患者(分别于治疗前及抗抑郁药物治疗8周后)和14例性别、年龄相匹配的正常志愿者进行静息态fMRI检查,运用REST、SPM2分析软件,进行全脑分析,比较基于ALFF的BOLD信号变化。结果:治疗前患者组“默认模式”神经网络的ALFF较正常对照组普遍性减低(P＜0.001,uncorrected)。经8周有效治疗后,右侧扣带回前部及双侧背外侧额叶、右侧眶额叶、颞叶、双侧楔前叶、扣带回后部皮层、右侧枕叶视区BOLD信号较治疗前增高(P＜0.05,uncorrected)。结论:治疗有效的首发抑郁症患者静息态脑功能区的异常变化是可逆的;基于ALFF的静息态fMRI技术为临床更客观地动态评价抗抑郁药物疗效开辟一条新的思路。更多还原

【Abstract】 PARTⅠCortical abnormalities in first-onset major depressive disorder investigated with MRI and voxel-based morphometryObjective To study the structural changes of the whole brains in first onset major depressive disorder(MDD).Material and Methods Thirty-two patients with first onset MDD and 32 the age- and sex-matched control subjects were enrolled in the study.Gray volume differences of the whole brain were assessed using SPM2 to make voxel-based morphometry comparison between patients and the control subjects.Results The volume of the right hippocampus,amygdala and right medial occipital lobule was significantly smaller in the patient group than controls(P＜.05 FDR corrected).Conclusion Tendency of the reduced volume of the right hippocampus,amygdala and right medial occipital lobule was a characteristic of first onset major depressive disorder.PARTⅡWhite matter abnormalities and changes in first-onset major depressive disorder by antidepressant treatment investigated with voxel-based diffusion tensor imagingObjective To detect white matter abnormalities in patients with in first-onset major depressive disorder(MDD) and identify changes by antidepressant treatment.Material and Methods Thirteen patients with first onset MDD and 14 normal age-matched volunteers underwent diffusion tensor imaging(DTI) and patients underwent scanning twice during an 8-week period.Fractional anisotropy(FA) maps were processed using SPM2 to make voxel-wise comparison of anisotropy in whole brain between the two groups.Results Significant reductions in anisotropy were found in the white matter of genu of corpus callosum,genu of the right internal capsule and right inferior longitudinal fasciculus in patients(P＜.001 corrected).Symptomatic improvement after antidepressant was associated with reversion of the FA reductive areas (P＜.001 corrected).Conclusion Changes in FA maps of genu of corpus callosum, genu of the right internal capsule and right inferior longitudinal fasciculus associated with symptomatic improvement indicate that DTI may be a useful surrogate marker of antidepressant treatment response.PARTⅢNeural responses with emotional processing in first-onset major depressive disorder by antidepressant treatment investigated with functional MRIObjective To detect Changes of neural response toward sad and happy facial expressions in first-onset major depressive disorder(MDD) by antidepressant treatment investigated with functional magnetic resonance imaging(fMRI).Material and Methods Thirteen patients with with first onset MDD and 14 normal age-matched volunteers underwent fMRI and patients underwent scanning twice during an 8-week period.Blood oxygenation level dependent(BOLD) were processed using SPM2 to compare of function in whole brain between the two groups during exposure to neutral, positive and negative pictures.Results Incresesd activation of anterior cingulate cortex (ACC) during exposure to sad pictures and decreased activation of left laterial superior frontal cortex during exposure happy pictures were found in patients compared with control grougs(P＜.001,uncorrected).Symptomatic improvement after antidepressant was associated with reversion of ACC and left laterial superior frontal cortex(P＜.001, uncorrected).Conclusion Changes in BOLD of fMRI associated with symptomatic improvement indicate that fMRI may be a useful surrogate marker of antidepressant treatment response.PARTⅣAmplitude of low frequency fluctuation in first-onset major depressive disorder by antidepressant treatment investigated with resting-state functional MRIObjective To detect amplitude of low frequency fluctuation(ALFF) in patients with in first-onset major depressive disorder and identify changes by antidepressant treatment.Material and Methods Thirteen patients with with first onset major depressive disorder(MDD) and 14 normal age-matched volunteers underwent resting-state functional MRI and patients underwent scanning twice during an 8-week period.ALFF were processed using REST and SPM2 to compare resting-state function in whole brain between the two groups.Results Patients with MDD had decreased ALFF in "default-mode" network compared with control grougs(P＜.001,uncorrected). Symptomatic improvement after antidepressant was associated with reversion of the ALFF decreased areas in the right anterior cingulated cortex,right laterial inferior frontal cortex,right orbital frontal cortex,right temporal lobe,and bilateral posterior cingulated cortex(P＜.05,uncorrected).Conclusion Changes in ALFF maps of resting-state function associated with symptomatic improvement indicate that ALFF may be a useful surrogate marker of antidepressant treatment response.更多还原