Diffusion Kurtosis Imaging And Arterial Spin Marker Perfusion Imaging In Major Depression Disorder Patients Treated With Electroconvulsive Therapy

Background Major depressive disorder(MDD)is currently one of the very common mental disease.It is estimated that depression will be the largest global disease burden by 2030,but its pathogenesis remains unclear.Treatment options including medication,psychotherapy and physical therapy are limited.Electroconvulsive technology(ECT),as a physical therapy technology,is one of the most effective methods of treating depression around the world.But the mechanism which ECT can relieve patients’ depressive symptoms remains unclear.Functional magnetic resonance imaging(f MRI)has been widely used in the scientific research of depression and other mental diseases in recent years,but the diffusion kurtness imaging(DKI)and arterial spin-labeled perfusion imaging(ASL)technologies have not or rarely been used in studying mechanism of ECT in the treatment of depression.In this study,ASL and DKI will be detected to determine whether the regional cerebral blood flow(r CBF)and the gray matter fiber change before and after ECT in MDD patients.At the same time,changes of brain regions,trend,and correlation with depressive symptoms will be determined.This will be helped in understanding the pathogenesis of depression and the mechanism of ECT in treatment of depression.Methods MDD patients will be recruited according to the inclusion criteria,and divided into the ECT group(ECT and antidepressants)and the medication group(antidepressant)according to their willingness to receive ECT treatment.Subjects in the ECT group received 6 ECT treatments within 2 weeks,and all subjects received a MRI scan before and after 2 weeks of treatment.Ax 3D T1BRAVO/ ASL/DKI sequences were scanned on GE Signa Discovery fiber 3.0 T superconducting magnetic resonance scanner.The f MRI data analysis using Matlab R2012 b software.SPM12(Statistical Parametric Mapping 12)and REST-V1.8(Resting-State f MRI Data Analysis Toolkit V1.8)were used for Data processing.The r CBF and DKI raw image data of the subjects were processed on the GE AW4.6 workstation.The software toolkit(simultaneously processing ASL and DKI data)was used to generate the original FA,MD,AD,RD,DA,KFA,MK,AK and RK parameter images.The acquired data are preprocessed in SPM software based on Matlab.Then the analysis software in the REST software was selected for the paired sample t test,compared the changes before and after treatment in each group.Alphasim correction was performed using Slice Viewer in Rest software,cluster>75 voxels,p<0.05 was statistically significant.The MNI coordinates were recorded,the different brain regions were detected,and the t value was recorded.Brain Net viewer_v1.43 pairs of brain regions with different structures were displayed on the 3D glass brain image.The difference brain regions were marked as region of interests(ROIs).Xjview was used to set the difference brain regions as the standard brain.The standard brain was used to extract the relevant ROIs values by Rest software.The correlation of ROIs to the scores of Hamilton Depression Scale(HAMD)and Life Satisfaction Rating Scales(LSRS)was analyzed.Results A total of 32 subjects were recruited in this study.Ten in ECT group and 12 in medication group who completed the whole study and the imaging data met the analysis requirements.RK increased in the frontal and temporal lobes,and there was no significant change in residual DKI parameters.In the ECT group,r CBF decreased in the frontal lobe,while MK decreased in the left frontal lobe and occipital lobe.RK decreased in the left occipital lobe and frontal lobe,and increased in the right angular gyrus and cingulate gyrus.AK increased in the right temporal lobe,hippocampal gyrus,thalamus and hippocampus,and decreased in the left frontal lobe.MD was mainly increased in the left temporal lobe,frontal lobe and cingulate gyrus,and decreased in the right temporal lobe,insula and parahippocampal gyrus.KFA increased in the right hippocampal gyrus,temporal lobe and occipital lobe.FA increases in the temporal lobe and hippocampus.In medication group,r CBF decreased in the temporal lobe and MK increased in the temporal lobe and angular gyrus.The results of this study suggested that:patients treated with ECT had more abnormal DKI parameters and a wider coverage of ROIs region compared with patients only treated with antidepressants,.But the changes were predominately located in the frontal,temporal and occipital lobes.HAMD and LSRS scores decreased or increased in all patients compared to the beginning of treatment,but it was more significant in ECT group than in medication group.Conclusion The parameter values of r CBF and DKI and the corresponding ROIs range in MDD patients treated with ECT were more than those of medication group.Meanwhile,the improvement of HAMD-17 score and LSRS score in ECT group was more obvious than that in the drug group.We can conclude that antidepressants and ECT,all have to adjust the action of brain function in patients with MDD,but antidepressants and ECT,regulating the mechanism of brain function is not similar,but definitely ECT to adjustment is not limited to a particular brain regions of cerebral blood flow and gray matter fiber to change.The results of this study may provide some evidence for the pathogenesis and therapeutic mechanism of ECT in the treatment of depression,which may be helpful for the exploration of therapeutic biomarkers related to effective ECT.