A Magnetic Resonance Spectrum Imaging Study In Frontal Lobe And Hippocampus Of Patients With Bipolar Depressive Disorder

Objectives: To study magnetic resonance spectroscopy characteristics which would be relevantto the clinical features in patients with bipolar depressive disorder, and to explore the roles ofN-acetylaspartate, choline-containing compound, and creatine which played in thepathogenesis of bipolar depressive disorder.Methods:34patients with bipolar depressive disorder(BDD) and11normal controls(NC) wererecruited in the study through strict structural clinical interview, using the MINI InternationalNeuropsychiatric terview for DSM-Ⅳ. Then the subjects were investigated by questionnairesincluding the General Situation Questionnaire, Hamilton Depression Scale(HAMD), HamiltonAnxiety Scale(HAMA), Pittsburgh Sleep Quality Index(PSQI), Mood Disorder Questionnaire(MDQ), Hypomania Symptom Check List (HCL-32) and Young Mania Rating Scale(YMRS).After all the clinical symptoms had been expressed, the subjects were scanned by GE1.5T SignaHD MR in order to get their magnetic resonance spectroscopy imaging. The SPSS13.0analysissoftware was used to record a data base and perform the statistic analysis.Results:1. Cr in bilateral f rontal lobe, NAA and Cho in right f rontal lobe were significantlylower in BDD patients versus NC(P<0.05); NAA, Cho and Cr in bilateral hippocampus weresignif icantly lower in BDD patients versus NC(P<0.05), but Cho/Cr in right hippocampus washigher in BDD patients versus NC(P<0.05).2. Cho in right hippocampus was significantly lower than that in left hippocampus inBDD patients(P<0.05).3. Cho and Cho/Cr in right frontal lobe and Cho in left hippocampus in female BDDpatients were significantly lower than those in male BDD patients(P<0.05).4. NAA, Cho and Cr in bilateral frontal lobe and Cho/Cr in left frontal lobe weresignigicantly different among BDDⅠpatients, BDDⅡ patients and NC(P<0.05). Besides, NAAand Cho in bilateral frontal lobe, Cho/Cr in left frontal lobe and Cr in right frontal lobe werehigher in BDDⅠpatients than those in BDDⅡ patients(P<0.05). Then NAA, Cho and Cr inbilateral hippocampus were significantly different among BDDⅠpatients, BDDⅡ patients andNC(P<0.05). Additionally, Cho in bilateral hippocampus, NAA in left hippocampus and Cr inright hippocampus were higher in BDDⅠpatients than those in BDDⅡ patients(P<0.05).5. Cho and Cr in bilateral hippocampus and NAA in right frontal lobe and righthippocampus were significantly different among first-episode BDD patients, recurrent BDD patients and NC(P<0.05). But there were no significant differences in magnetic resonancespectroscopy characteristics between first-episode BDD patients and recurrent BDDpatients(P>0.05).6. Cr in right frontal lobe and NAA/Cr and Cho/Cr in left hippocampus in BDD patientswere negatively related to the scores of HAMD, but Cho/Cr in right frontal lobe was positivelyrelated to the scores of HAMD. However, there were no significant relations between magneticresonance spectroscopy characteristics in left frontal lobe and right hippocampus and scores ofHAMD in BDD patients. There were also no significant relations between magnetic resonancespectroscopy characteristics and scores of HAMA in BDD patients. Moreover, NAA, Cho andNAA/Cr in bilateral frontal and Cr in right frontal lobe were negatively related to the scores ofPSQI, but there were no significant relations between Cho/Cr in bilateral frontal lobe and scoresof PSQI; NAA, Cho and Cr in bilateral hippocampus were negatively related to scores of PSQI,but NAA/Cr and Cho/Cr in right hippocampus were positively related to scores of PSQI.Nevertheless, there were no significant relations between NAA/Cr and Cho/Cr in lefthippocampus and scores of PSQI.Conclusions: Magnetic resonance spectroscopy characteristics and clinical features of34patients with bipolar depressive disorder and11normal controls were analysed, obtainingfollowing conclusions:1. NAA, Cho and Cr in bilateral frontal lobe and hippocampus all patispate in pathogenesisof bipolar depressive disorder.2. Metabolic dysfunction in right hippocampus was more serious than that in lefthippocampus of BDD patients, and Cho was a biomarker which indicated the unbalance betweenbilateral hippocampus of BDD patients.3. Metabolic dysfunction in frontal lobe and hippocampus of female BDD patients wasmore serious than that of male BDD patients, moreover, Cho was a biomarker which indicatedthe unbalance between female and male BDD patients.4. The levels of NAA, Cho and Cr in centrl nervous system of BDDⅡpatients were moretangled than those of BDDⅠpatients.5. The levels of NAA, Cho and Cr in centrl nervous system of recurrent BDD patients wereinordinate.6. Depressive symptoms and subjective sleep quality are major factors that influence onmagnetic resonance spectroscopy characteristics of patients with bipolar depressive disorder.