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Free PDF Download European Review for Medical and Pharmacological Sciences 2017; 21: 1541-1550 Difference in resting-state fractional amplitude of low-frequency fluctuation between bipolar depression and unipolar depression patients H.-L. YU1, W.-B. LIU1, T. WANG2, P.-Y. HUANG2, L.-Y. JIE2, J.-Z. SUN2, C. WANG2, W. QIAN2, M. XUAN2, Q.-Q. GU2, H. LIU1, F.-L. ZHANG3, M.-M. ZHANG2 1Department of Psychiatry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China 2Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China 3Hangzhou No. 4 High School, Hangzhou, Zhejiang Province, China Abstract. – OBJECTIVE: To investigate the left middle occipital gyrus, right middle tempo- difference in fractional amplitude of low-fre- ral gyrus, left middle frontal gyrus, and left me- quency fluctuation (fALFF) of localized brain ac- dial frontal gyrus. tivities in the resting-state between bipolar de- CONCLUSIONS: The brain activities of BD and pression and unipolar depression patients and UD patients in the resting-state exhibit abnor- to find biological markers that differentiate the malities, which differ between the two groups two groups of patients. of patients. PATIENTS AND METHODS: Thirteen patients with bipolar depression, 15 patients with unipo- Key Words: lar depression, and 16 healthy control subjects Unipolar depression, Bipolar depression, Rest- that were matched in age and years of education ing-state, Functional magnetic resonance, Fractional were subjected to 3.0 T resting-state functional amplitude of low- frequency fluctuation. magnetic resonance scans. The values of whole brain fALFF were calculated and statistical anal- ysis was performed. RESULTS: The fALFF-values of the right in- Introduction ferior temporal gyrus, left cerebellar posterior lobe, right middle temporal gyrus, left inferior Bipolar depression (BD) and unipolar depres- frontal gyrus/insula, right inferior frontal gyrus/ sion (UD) are two common types of affective insula, left lingual gyrus and right middle tem- disorder. The differential diagnosis of these con- poral gyrus of the three groups showed signif- ditions continues to be based on the symptom- icant differences (p < 0.05). Compared with the healthy control (HC) group, the fALFF-values of atology and the course of the disease. BD and UD the unipolar depression (UD) patient group sig- are similar symptomologies, such as depressed nificantly increased in the right superior tempo- mental state, thinking slow, volitional activity ral gyrus, left insula, left inferior frontal gyrus, drops, and so on. Although mania or hypomania right inferior frontal gyrus, right supramarginal is a defining feature of BD patients, the presence gyrus and right medial frontal gyrus but signifi- of subthreshold manic symptoms can be observed cantly decreased in the right medial occipital gy- in both disorders during a depressive episode. rus, left frontal lobe, right superior parietal lob- ule; the fALFF-values of the bipolar depression This leads to a difficulty in distinguishing BD (BD) patient group significantly decreased in from UD patients as they have the same diagnos- the left cerebellum posterior lobe, right lingual tic criteria for the first depressive episode1. Stud- gyrus, left lingual gyrus, right middle temporal ies2 have shown that nearly 60% of BD patients gyrus, left middle temporal gyrus, and left su- were initially misdiagnosed as UD. Therefore, perior frontal gyrus and significantly increased it is of particular importance to find objective in the right inferior frontal gyrus and left insula compared to those of the HC group; compared biomarkers that distinguish BD and UD, so that with those of the UD group, the fALFF-values bases for early diagnosis and correct treatment of of the BD group significantly decreased in the the two diseases can be found. Corresponding Author: Min-Ming Zhang, MD; e-mail: [email protected] 1541 H.-L. Yu, W.-B. Liu, T. Wang, P.-Y. Huang, L.-Y. Jie, J.-Z. Sun, et al. Functional magnetic resonance imaging (fM- tical Manual of Mental Disorders (the 4th edition)” RI) is a noninvasive research tool that has been (DSM-IV); (2) of Han Chinese and Chinese na- widely used in the study of psychiatric disorders tionality; (3) right-handed; (4) 18-50 years of age; in recent years. Task-state fMRI has been used (5) score > 21 points on the 24-item Hamilton De- to compare BD and UD. It has been shown that pression Scale (HAMD-24); and score < 5 points when facing grief and fear scenarios, BD patients on the Young Manic Rating Scale (YMRS). Ex- are more prone to activate the left amygdala3 clusion criteria were as follows: (1) brain organic but to reduce the top-down effective connection mental disorders; (2) substance-induced mental between the left ventral midline prefrontal cor- disorders; (3) serious physical illness; (4) a his- tex and amygdala when in pleasant situations4. tory of electrotractive treatment; and (5) MRI Some researchers have argued that activity in contraindications. the ventral and dorsal sides of the prefrontal cor- Fifteen patients were included in the UD group, tex of UD patients is much lower5, while that in based on the following inclusion criteria: (1) com- the anterior and back of cingulate gyrus of UD pliance with the diagnosis standard for unipolar patients is significantly elevated compared with depression of “The Diagnostic and Statistical that of BD patients5. Relative to investigations of Manual of Mental Disorders (the 4th edition)” task-state fMRI6, studies that directly compare (DSM-IV); (2) of the Han Chinese and Chinese BD and UD using resting-state fMRI have been nationality; (3) right-handed; (4) 18-50 years of rare, although some studies have found that the age; (5) score > 21 points on the HAMD-24; amplitude of low-frequency fluctuation (ALFF) and score < 5 points on the Young Mania Rat- values of BD patients in the left superior parietal ing Scale (YMRS). Exclusion criteria were as lobule and the posterior of left insula are higher follows: (1) brain organic mental disorders; (2) than those of UD patients while also exhibiting substance-induced mental disorders; (3) serious increased ALFF-values in the anterior dorsal of physical illness; (4) a history of electrotractive the right insula. However, ALFF is sensitive to treatment; and (5) MRI contraindications. physiological noise, whereas fractional amplitude Sixteen gender-, age- and education-matched of low-frequency fluctuations (fALFF) can effec- subjects were included in the HC group, based on tively inhibit nonspecific signals of the cisternal the following inclusion criteria: (1) 18-50 years area, reduce physiological noise interference and of age; (2) not been diagnosed with disorders, improve the sensitivity and specificity of the de- according to DSM-IV-IR axis I or DSM-IV-IR tection of spontaneous brain activities7. Therefore, axis II; (3) no family history of mental illness; (4) in this work, the resting-state functional magnetic does not suffer from any disease or has not taken resonance method was employed to compare the any drug within one month before the scan; and fALFF-values of UD and BD patients. (4) score < 7 points on the HAMD-24, and score < 5 points on the YMRS. This study was approved by the Medical Ethics Patients and Methods Committee of the Second Affiliated Hospital of Zhejiang University Medical College. All sub- Patients jects or their family members voluntarily par- The patients were recruited from outpatients ticipated in the study and signed the informed and inpatients admitted to the psychiatric clinics consent agreement. of the Second Affiliated Hospital of Zhejiang University, China, from September 2011 to Sep- tember 2016. The patients were diagnosed by two Methods clinically experienced psychiatrists (both above the rank of attending physician) using the struc- Magnetic Resonance Data Acquisition tured clinical interview method for DSM-IV-IR A GE SIGNA 3.0T magnetic resonance imager axis I-disorders. Subjects in the healthy control was used to acquire brain structure and function (HC) group were recruited through advertise- images of subjects. At the time of scanning, sub- ment. All subjects were right-handed. jects were awake, with their eyes closed and head Thirteen patients were included in the BD fixed, and were quietly lying on the examination group, based on the following inclusion criteria: bed without performing any specific cognitive (1) compliance with the diagnosis standard for tasks. They were informed that they should try bipolar depression of “The Diagnostic and Statis- to avoid systemic thinking activities. The scan 1542 Neuroimaging studies of mental disorder sequence and parameters were as follows. Ana- gether and divided by the total of ALFF-values tomical images were obtained using fast spoiled in the range of 0.01-0.25 Hz, resulting in the gradient echo (FSPGR) with the following pa- fALFF-value. Bandpass filtering of 0.01-0.08 rameters: TR = 5 ms, TE = 1.1 ms, TI = 400 ms, Hz was then performed to avoid the effect of flip angle = 15°, slice thickness = 1.2 mm, interval physiological noise, such as heart rate, respi- = 0 mm, FOV = 240 mm × 240 mm, and matrix ratory rhythm, etc. The whole brain voxel was = 256 × 256. A total of 136 slices were acquired normalized by dividing the fALFF-value of from the whole brain, with a scanning time of 5 each voxel by the mean of the ALFF-values of min 50 s. Images of brain structures not found the whole brain signals. with significant abnormalities were acquired through a resting-state functional scan, which Statistical Analysis was conducted using the spin echo-echo planar SPM8 software was used to perform Analysis imaging (SE-EPI) sequence with the following of Variance (ANOVA) on the three groups of sub- scan parameters: TR/TE = 2000 ms/30 ms, FOV jects, and a pair-wise sample t-test was conducted = 240 mm × 240 mm, matrix = 64 × 64, and slice on the basis of differences in the brain regions.
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