Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for treatment of major depression

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Object. Neurosurgical procedures are a viable intervention for severe, treatment-refractory major depression, although they have been associated with only modest rates of efficacy. The purpose of this study was to identify possible neuroimaging predictors of treatment response to anterior cingulotomy in patients with major depression.

Methods. Thirteen patients underwent stereotactic anterior cingulotomy for treatment-refractory major depression. Symptom severity was measured using the Beck Depression Inventory (BDI) both before and approximately 12 months after surgery. The authors performed [18F]fluorodeoxyglucose—positron emission tomography (PET) studies in all patients preoperatively. Statistical parametric mapping methods were used to test for loci of significant correlation between preoperative regional cerebral metabolism and postoperative reduction in BDI scores.

The mean (± standard deviation) change in the BDI score from the preoperative period (43.7 ± 7.8) to the postoperative period (30.5 ± 21.3) was 33.1 ± 45.4%. Two loci—the left subgenual prefrontal cortex and left thalamus—were identified as sites at which preoperative metabolism was significantly correlated with subsequent improvement in depressive symptom severity following cingulotomy. Specifically, higher preoperative rates of metabolism at these loci were associated with better postoperative results.

Conclusions. Possible PET scanning predictors of treatment response were identified in patients with major depression who had undergone anterior cingulotomy. Further research will be necessary to determine the reproducibility of this finding. If confirmed, the availability of an index for noninvasively predicting a patient's response to cingulotomy for the treatment of major depression would be of great clinical value.

Article Information

Address reprint requests to: Scott L. Rauch, M.D., Department of Psychiatry, Massachusetts General Hospital-East, 9th Floor, Building 149, 13th Street, Charlestown, Massachusetts 02129. email: rauch@psych.mgh.harvard.edu.

© AANS, except where prohibited by US copyright law.

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    Upper Left and Right, Lower Left: Nominally structural MR images transformed to MNI space illustrating the principal finding of a statistically significant correlation between preoperative rCMRG (CMRglu) within the left subgenual prefrontal cortex and BDI score improvement following cingulotomy. These panels demonstrate the locus of significant correlation, as viewed from three conventional orthogonal perspectives. The intersection of the cross-hairs corresponds to the site of peak correlation (z score 3.32; MNI coordinates −8, 24, and −8); this defines the voxel of peak statistical significance used to generate the data depicted graphically (lower right). Specifically, for this voxel, the Pearson productmoment correlation between rCMRG and BDI score improvement yielded r2(11) = 0.81; p = 0.001.

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    Upper Left and Right, Lower Left: Nominally normal structural MR images transformed to MNI space illustrating the principal finding of a statistically significant correlation between preoperative rCMRG within the left posterior thalamus and BDI score improvement following cingulotomy. These panels demonstrate the locus of significant correlation, as viewed from three conventional orthogonal perspectives. The intersection of the cross-hairs corresponds to the site of peak correlation (z score 4.18; MNI coordinates −16, −32, and 12); this defines the voxel of peak statistical significance used to generate the data depicted graphically (lower right). Specifically, for this voxel, the Pearson product-moment correlation between rCMRG and BDI score improvement yielded r2(11) = 0.9; p < 0.001.

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