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, 175 (10), 989-998

Meta-Analysis of 89 Structural MRI Studies in Posttraumatic Stress Disorder and Comparison With Major Depressive Disorder


Meta-Analysis of 89 Structural MRI Studies in Posttraumatic Stress Disorder and Comparison With Major Depressive Disorder

Konstantinos Bromis et al. Am J Psychiatry.


Objective: The authors conducted a comprehensive meta-analysis of MRI region-of-interest and voxel-based morphometry (VBM) studies in posttraumatic stress disorder (PTSD). Because patients have high rates of comorbid depression, an additional objective was to compare the findings to a meta-analysis of MRI studies in depression.

Method: The MEDLINE database was searched for studies from 1985 through 2016. A total of 113 studies met inclusion criteria and were included in an online database. Of these, 66 were selected for the region-of-interest meta-analysis and 13 for the VBM meta-analysis. The region-of-interest meta-analysis was conducted and compared with a meta-analysis of major depressive disorder. Within the region-of-interest meta-analysis, three subanalyses were conducted that included control groups with and without trauma.

Results: In the region-of-interest meta-analysis, patients with PTSD compared with all control subjects were found to have reduced brain volume, intracranial volume, and volumes of the hippocampus, insula, and anterior cingulate. PTSD patients compared with nontraumatized or traumatized control subjects showed similar changes. Traumatized compared with nontraumatized control subjects showed smaller volumes of the hippocampus bilaterally. For all regions, pooled effect sizes (Hedges' g) varied from -0.84 to 0.43, and number of studies from three to 41. The VBM meta-analysis revealed prominent volumetric reductions in the medial prefrontal cortex, including the anterior cingulate. Compared with region-of-interest data from patients with major depressive disorder, those with PTSD had reduced total brain volume, and both disorders were associated with reduced hippocampal volume.

Conclusions: The meta-analyses revealed structural brain abnormalities associated with PTSD and trauma and suggest that global brain volume reductions distinguish PTSD from major depression.

Keywords: Brain Imaging Techniques; Posttraumatic Stress Disorder.


Figure 1
Figure 1. Meta-Analysis of Continuous Data Comparing Patients With Posttraumatic Stress Disorder and Control Subjectsa
a Hedges’ g (Cohen effect size with small-sample correction) is shown for each structure, with 95% confidence intervals. The effect size is positive when the structure is larger in patients with PTSD compared with control subjects and negative when the structure is smaller in PTSD patients. The number of studies included in each meta-analysis is indicated for each structure.
Figure 2
Figure 2. Seed-Based d Mapping (SDM) Meta-Analysis of 13 Voxel-Based Morphometry Studies Showing Significant Decreased Gray Matter Volumes in the PTSD Group Compared With All Control Subjectsa
a Color bar indicates SDM z scores. Peak change coordinates, 6, 32, 28. SDM z score=4.5. Detailed coordinates are listed in Table S8 in the online supplement. The t-map of this image is available at

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