The Study On Therapeutic Effect And Assessment In Patients With Depressive Disorder By ～(99m)Tc-ECD Cerebral Blood Perfusion Imaging

Background and objectiveThe depressive disorder is commonly-seen mood disorder in psychology department. The prevalence were 7% to 8% the recurrence rate were 50%. According to international survey of drugs in 2001, anti-depression drugs consist of 3 of 10 which were used the most often. Fifty percent to seventy percent suicide were from the patients with depressive disorder. The WHO predicted that the depression would be the second death, disable cause, and the most seriously disease in the developing country. So to diagnose and treat the depression were already one of most important question the human cared for. Psychiatrist were hoping diagnose and treat this disease through neurology, physiology, and imageology. Along with development of the function imageology, the function imaging technology had been one of tools that were used to study and diagnose diseases in neurology and psychology department. Single photon emission computed tomography and positron emission tomography provide the study on cerebral blood perfusion, metabolism, neuro-transmitter receptor, function and instruction in all kinds of nerve, mental disease.Most aim of cerebral blood perfusion imaging was to observe the characteristic of regional cerebral blood flow in depressive patients who were attacking, there were few study on change after antidepressant. There was growing evidence of a relationship between frontal neuroimaging and neuropsychological abnormalities and the physiopathology and course of the major depression. The aim of this study is to observe the cerebral blood perfusion change of the patients with depressive disorder compare the result before and after treatment and evaluate antidepressant response in depression in relation to frontal perfusion rations before treatment.Material and methodThirty-six unmediated depressive patients who were diagnosed by CCMD-2-R. All the patients received Fluoxetine treatment for 10 weeks. All of subjects who were rated at the end of the 10-week treatment with the Hamilton Rating Scale for depression and the Clinical Therapeutic Effect Rating Scale, 21 were classified as the remitters and 11 non-remitters. All depressive patients accepted cerebral blood perfusion imaging before and after treatment. Scan method: cerebral perfusion imaging was performed in all patients after injecting technetium-99m ethylcysteinate dimmer (⁹⁹Tc-ECD) 111OMBq. To observe result with visual examination and semi-quantitative analysis. Abnormality criteria: radioactivity rarefaction, defect area and concentrations above two slice and two fault in successive through two senior physicians diagnosis. Semi-quantitative analysis : irregular regional of interest(ROI) stored in the computer were performed. For each hemisphere , brain lobe regional radioactivity rations were obtained as mean counts per pixel of regional of interest divided by the mean counts per pixel of cerebellar ROI. Statistical method: Comparisons RAR after and before treatment were assessed by using the Analysis of Variance for continuous variables and the chisquare test for discrete variables. The level of statistical significance was set at P<0.05. Logistic regression methods were used to define a predictive model of non-remission.Results1. Thirty-three patients with depression were showed different degree and position of lower perfusion region, twenty-nine patients were showed lower perfusion regions in anterior frontal lobe, twenty-three in cingulate gyrns, sixteen in temporal cortex, ten in parietal cortex, nine in occipital cortex. Most lower perfusion regions were showed in anterior frontal lobe and cingulate gyrus.2. Remitters with Hamilton score (HAMD)≥60%,there were significantly increase in the blood flow of cingulate gyms, right temporal cortex after fluoxetine treatment except 2 of the remitters had normal perfusion. Before and after treatment cingulate gyrus RAR were 85.1±6.4 and 95.2±7.1 C r=3.15, P< 0.05 )and right temporal cortex RAR 75.4+7.5 and 86.3 + 6.8 (t=2A9, P< 0.05). There were significantly statistic difference in cingulate gyrus and right temporal cortex comparison to cerebral blood perfusion imaging before treatment. There were increase in the blood flow of anterior frontal cortex, right parietal cortex, and occipital lobe, there were not statistic difference in those regions.3. A total of 36 patients completed the study, twenty-one were classified as remitters and 11 as non-remitters. Left anterior frontal RAR of remitters and non-remitters were 73.45±7.10 and 80.32+6.91 (t=6.51, P<0.001).Right anterior frontal RAR of remitters and non-remitters were 77.90+6.30 and 83.02±6.48 (t= 2.35, P=0.02). Current episode duration of remitters and non-remitters were 4.15±1.56 months and 8.64+1.98 months (t=3.14, P=0.003). Comparison clinical variables between remitters and non-remitters, there were Significant differences in right and left anterior frontal cortex and current episode duration.4. Of the four frontal areas assessed (left and right anterior frontal and left and right posterior frontal) the predictive model included only the left anterior frontal ratio (LAFR) (wald x 2=12.08; d.f.=l; p≤0.01) . To improve the predictive model, the second stage assessed both the baseline functional neuroimaging variables and the baseline clinical and demographic variables. The global predictive model included LAFR (wald x²=5.9; d.f.=l; p≤0.01) , current episode duration(wald x²=4.61; d.f.=1; p=0.03) and current age (wald x²=3.41; d.f.=1; p=0.07), which hinted those variables were related to the bad therapeutic effect. the left anterior frontal ratio was the most Significant differences.Conclusion1. Patients with depression disorder showed lower cerebral blood perfusion region, mainly in prefrontal lobe and cingulate gyrus, where were both anatomy structure of mood cognition response and path site of the depression current.2. There were significantly increase in the cerebral blood perfusion of the remitters, so the therapeutic effect can be detected through the brain perfusion scan.3. The result of left prefrontal perfusion can predict the response to fluoxetine, and help clinical doctor to chose the best treatment ways by cerebral blood perfusion imaging before treatment.