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, 54 Suppl 1, S62-8

Patterns of Altered Cortical Perfusion and Diminished Subcortical Integrity in Posttraumatic Stress Disorder: An MRI Study

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Patterns of Altered Cortical Perfusion and Diminished Subcortical Integrity in Posttraumatic Stress Disorder: An MRI Study

Norbert Schuff et al. Neuroimage.

Abstract

Posttraumatic stress disorder (PTSD) accounts for a substantial proportion of casualties among surviving soldiers of the Iraq and Afghanistan wars. Currently, the assessment of PTSD is based exclusively on symptoms, making it difficult to obtain an accurate diagnosis. This study aimed to find potential imaging markers for PTSD using structural, perfusion, and diffusion magnetic resonance imaging (MRI) together. Seventeen male veterans with PTSD (45 ± 14 years old) and 15 age-matched male veterans without PTSD had measurements of regional cerebral blood flow (rCBF) using arterial spin labeling (ASL) perfusion MRI. A slightly larger group had also measurements of white matter integrity using diffusion tensor imaging (DTI) with computations of regional fractional anisotropy (FA). The same subjects also had structural MRI of the hippocampal subfields as reported recently (W. Zhen et al. Arch Gen Psych 2010;67(3):296-303). On ASL-MRI, subjects with PTSD had increased rCBF in primarily right parietal and superior temporal cortices. On DTI, subjects with PTSD had FA reduction in white matter regions of the prefrontal lobe, including areas near the anterior cingulate cortex and prefrontal cortex as well as in the posterior angular gyrus. In conclusion, PTSD is associated with a systematic pattern of physiological and structural abnormalities in predominantly frontal lobe and limbic brain regions. Structural, perfusion, and diffusion MRI together may provide a signature for a PTSD marker.

Figures

Figure 1
Figure 1
Representative maps of regional cerebral blood flow (rCBF - after fusion with structural MRI and partial volume correction) from two trauma exposed veterans, one diagnosed with PTSD (PTSD+, age =34 years, CAPS = 80) and another without PTSD (PTSD-, age = 22 years, CAPS = 13). The arrows in the rCBF maps point to the inferior posterior lobule, which showed a systematic increase in rCBF in PTSD.
Figure 2
Figure 2
Statistical parametric maps of significantly increased regional cerebral blood flow (rCBF) in PTSD relative to controls.
Figure 3
Figure 3
Statistical maps of significant reduction in fractional anisotropy (FA, shown in blue) in PTSD relative to control subjects (p = 0.001, uncorrected). Areas of significant FA reduction include regions near the anterior cingulate cortex (ACC), prefrontal cortex (PFC), posterior central gyrus (PCG) and angular gyrus (AG). FA reductions in PTSD are also seen in the posterior internal capsule (pIC). FA increase (orange) is seen at a single location in an unspecific anatomical region (far right image in the top row).

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