Cross-sectional Analysis of Whole-brain Microstructural Changes in Adult Patients with Bipolar and Unipolar Depression by Diffusion Kurtosis Imaging

Overview

Journal Neuroradiol J

Publisher Sage Publications

Specialties Neurology
Radiology

Date 2022 Jul 11

PMID 35817080

Authors

Muniraju Maralakunte

Vivek Gupta

Sandeep Grover

Chirag Kamal Ahuja

Swapnajeet Sahoo

Kamal Kishore

Sameer Vyas

Gaurav Garg

Paramjeet Singh

Varan Govind

Affiliations

Soon will be listed here.

Abstract

Rationale And Objectives: More than half of the bipolar depression (BD) subjects are misdiagnosed as unipolar depression (UD) due to lack of objective diagnostic criteria. We aimed to identify microstructural neuronal changes differentiating BD from UD groups using diffusion kurtosis imaging (DKI). The objective of the study is to identify an objective neuro-imaging marker to differentiate BD from UD.

Materials And Methods: A prospective, cross-sectional study included total of 62 subjects with diagnosis of bipolar depression ( = 21), unipolar depression ( = 21), and healthy controls ( = 20). All subjects underwent diffusion-weighted imaging (b = 0,1000,2000) of the whole brain on 3-Tesla MR scanner. DKI data was analyzed using 189 region whole-brain atlas. Eight diffusion and kurtosis metrics including mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), and kurtosis fractional anisotropy (FKA) were measured against these 189 regions. Principle component analysis (PCA) was utilized to identify the most significant regions of the brain. ANOVA with post hoc tests was used for analyzing these regions.

Results: BD group showed increased MD, RD, decreased AK at the left amygdala and decreased MK and RK at the right hemi-cerebellum. UD group showed increased MK and RK at the right external capsule; and increased AK, MK, and RK at the right amygdala.

Conclusion: The right and left amygdala, right external capsule, and right hemi-cerebellum showed microstructural abnormalities capable of differentiating BD and UD groups. Diffusion imaging especially DKI can aid in management of depression patients.

Citing Articles

Robust, fast and accurate mapping of diffusional mean kurtosis.

Farquhar M, Yang Q, Vegh V Elife. 2024; 12.

PMID: 39374133 PMC: 11458175. DOI: 10.7554/eLife.90465.

Principal component analysis as an efficient method for capturing multivariate brain signatures of complex disorders-ENIGMA study in people with bipolar disorders and obesity.

McWhinney S, Hlinka J, Bakstein E, Dietze L, Corkum E, Abe C Hum Brain Mapp. 2024; 45(8):e26682.

PMID: 38825977 PMC: 11144951. DOI: 10.1002/hbm.26682.

References

Uchida M, Serra G, Zayas L, Kenworthy T, Faraone S, Biederman J . Can unipolar and bipolar pediatric major depression be differentiated from each other? A systematic review of cross-sectional studies examining differences in unipolar and bipolar depression. J Affect Disord. 2015; 176:1-7. DOI: 10.1016/j.jad.2015.01.037. View

Almeida J, Versace A, Hassel S, Kupfer D, Phillips M . Elevated amygdala activity to sad facial expressions: a state marker of bipolar but not unipolar depression. Biol Psychiatry. 2009; 67(5):414-21. PMC: 2854029. DOI: 10.1016/j.biopsych.2009.09.027. View

Grotegerd D, Stuhrmann A, Kugel H, Schmidt S, Redlich R, Zwanzger P . Amygdala excitability to subliminally presented emotional faces distinguishes unipolar and bipolar depression: an fMRI and pattern classification study. Hum Brain Mapp. 2013; 35(7):2995-3007. PMC: 6869222. DOI: 10.1002/hbm.22380. View

Jolliffe I, Cadima J . Principal component analysis: a review and recent developments. Philos Trans A Math Phys Eng Sci. 2016; 374(2065):20150202. PMC: 4792409. DOI: 10.1098/rsta.2015.0202. View

Zhao L, Wang Y, Jia Y, Zhong S, Sun Y, Zhou Z . Cerebellar microstructural abnormalities in bipolar depression and unipolar depression: A diffusion kurtosis and perfusion imaging study. J Affect Disord. 2016; 195:21-31. DOI: 10.1016/j.jad.2016.01.042. View

Steven A, Zhuo J, Melhem E . Diffusion kurtosis imaging: an emerging technique for evaluating the microstructural environment of the brain. AJR Am J Roentgenol. 2013; 202(1):W26-33. DOI: 10.2214/AJR.13.11365. View

de Almeida J, Phillips M . Distinguishing between unipolar depression and bipolar depression: current and future clinical and neuroimaging perspectives. Biol Psychiatry. 2012; 73(2):111-8. PMC: 3494754. DOI: 10.1016/j.biopsych.2012.06.010. View

Malhi G, Lagopoulos J, Sachdev P, Ivanovski B, Shnier R . An emotional Stroop functional MRI study of euthymic bipolar disorder. Bipolar Disord. 2005; 7 Suppl 5:58-69. DOI: 10.1111/j.1399-5618.2005.00255.x. View

Tabesh A, Jensen J, Ardekani B, Helpern J . Estimation of tensors and tensor-derived measures in diffusional kurtosis imaging. Magn Reson Med. 2011; 65(3):823-36. PMC: 3042509. DOI: 10.1002/mrm.22655. View

10.

Ceritoglu C, Oishi K, Li X, Chou M, Younes L, Albert M . Multi-contrast large deformation diffeomorphic metric mapping for diffusion tensor imaging. Neuroimage. 2009; 47(2):618-27. PMC: 2857762. DOI: 10.1016/j.neuroimage.2009.04.057. View

11.

Sofroniew M, Vinters H . Astrocytes: biology and pathology. Acta Neuropathol. 2009; 119(1):7-35. PMC: 2799634. DOI: 10.1007/s00401-009-0619-8. View

12.

Korgaonkar M, Grieve S, Koslow S, Gabrieli J, Gordon E, Williams L . Loss of white matter integrity in major depressive disorder: evidence using tract-based spatial statistical analysis of diffusion tensor imaging. Hum Brain Mapp. 2010; 32(12):2161-71. PMC: 6870076. DOI: 10.1002/hbm.21178. View

13.

Judd L, Akiskal H, Schettler P, Endicott J, Maser J, Solomon D . The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002; 59(6):530-7. DOI: 10.1001/archpsyc.59.6.530. View

14.

Raab P, Hattingen E, Franz K, Zanella F, Lanfermann H . Cerebral gliomas: diffusional kurtosis imaging analysis of microstructural differences. Radiology. 2010; 254(3):876-81. DOI: 10.1148/radiol.09090819. View

15.

Yoshida M, Hori M, Yokoyama K, Fukunaga I, Suzuki M, Kamagata K . Diffusional kurtosis imaging of normal-appearing white matter in multiple sclerosis: preliminary clinical experience. Jpn J Radiol. 2012; 31(1):50-5. DOI: 10.1007/s11604-012-0147-7. View

16.

Perlis R, Ostacher M, Goldberg J, Miklowitz D, Friedman E, Calabrese J . Transition to mania during treatment of bipolar depression. Neuropsychopharmacology. 2010; 35(13):2545-52. PMC: 3055576. DOI: 10.1038/npp.2010.122. View

17.

Delvecchio G, Fossati P, Boyer P, Brambilla P, Falkai P, Gruber O . Common and distinct neural correlates of emotional processing in Bipolar Disorder and Major Depressive Disorder: a voxel-based meta-analysis of functional magnetic resonance imaging studies. Eur Neuropsychopharmacol. 2011; 22(2):100-13. DOI: 10.1016/j.euroneuro.2011.07.003. View

18.

Judd L, Akiskal H, Schettler P, Coryell W, Endicott J, Maser J . A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003; 60(3):261-9. DOI: 10.1001/archpsyc.60.3.261. View

19.

Hui E, Fieremans E, Jensen J, Tabesh A, Feng W, Bonilha L . Stroke assessment with diffusional kurtosis imaging. Stroke. 2012; 43(11):2968-73. PMC: 3479373. DOI: 10.1161/STROKEAHA.112.657742. View

20.

Hirschfeld R, Lewis L, Vornik L . Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003; 64(2):161-74. View