ABSTRACT
Objective:To observe the changes in brain magnetic resonance imaging (MRI) in patients with major depressive disorder (MDD) after modified electroconvulsive therapy (MECT) relative to before treatment.Methods:A total of 105 patients with MDD who received treatment in Hangzhou Seventh People's Hospital and Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2017 to June 2019 were included in this study. The brain MRI data pre- and post-MECT were collected. These patients were divided into study group (abnormal brain structure, n = 51) and control group (normal brain structure; n = 54) according to brain structure pre-treatment as shown on MRI. Clinical efficacy, scores of the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety pre and post-treatment, and the incidence of complications were compared between the two groups. Results:MRI data revealed that 51 patients had abnormal brain structure, including 16 patients with hippocampal atrophy, 18 patients with brain volume reduction, 10 patients with intracranial cyst, and 7 patients with large occipital cistern. These patients had no obvious changes in brain structure after MECT compared with before MECT. The age of onset was lower in the study group than in the control group [(24.15 ± 1.64) years vs. (29.33 ± 2.71) years, t = -7.751, P < 0.05]. The proportion of female patients (57.4% vs. 47.1%), the proportion of patients with a family history of MDD (81.5% vs. 56.9%), and the proportion of patients with psychotic symptoms (55.6% vs. 35.3%) were significantly higher in the study group than in the control group ( χ2 = 4.96, 7.50, 4.33, all P < 0.05). Multivariate logistic regression showed that family history was a factor unrelated to MDD ( P = 0.997). Abnormal brain structure in patients with MDD was negatively correlated with age ( OR = 3.89, 95% CI = 2.083 - 7.281, P < 0.01) and it was positively correlated with sex and psychotic symptoms ( OR = 12.05, 0.08, 95% CI = 2.063 - 70.439, 0.010 - 0.698, both P < 0.05). The Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores decreased after MECT in both groups (both P < 0.05). The proportions of patients having dizziness/headache (50.98% vs. 27.78%), vomiting (43.14% vs. 22.22%), muscle soreness (29.41% vs. 11.11%), delirium (23.53% vs. 7.41%), and memory impairment (64.71% vs. 33.33%) were significantly higher in the study group than in the control group ( χ2 = 5.93, 5.24, 5.49, 5.27, 10.33, all P < 0.05). Conclusion:Most patients with MDD have an abnormal brain structure. Female patients at a low age of onset with psychotic symptoms tend to have an abnormal brain structure. MECT can greatly improve depressive symptoms and has no obvious impact on brain structure. Patients with MDD who have an abnormal brain structure are more likely to have complications.
ABSTRACT
Objective@#To investigate the accuracy of the Agatston score obtained with the ultra-high-pitch (UHP) acquisition mode using tin-filter spectral shaping (Sn150 kVp) and a kVp-independent reconstruction algorithm to reduce the radiation dose. @*Materials and Methods@#This prospective study included 114 patients (mean ± standard deviation, 60.3 ± 9.8 years; 74 male) who underwent a standard 120 kVp scan and an additional UHP Sn150 kVp scan for coronary artery calcification scoring (CACS). These two datasets were reconstructed using a standard reconstruction algorithm (120 kVp + Qr36d, protocol A; Sn150 kVp + Qr36d, protocol B). In addition, the Sn150 kVp dataset was reconstructed using a kVp-independent reconstruction algorithm (Sn150 kVp + Sa36d, protocol C). The Agatston scores for protocols A and B, as well as protocols A and C, were compared.The agreement between the scores was assessed using the intraclass correlation coefficient (ICC) and the Bland–Altman plot. The radiation doses for the 120 kVp and UHP Sn150 kVp acquisition modes were also compared. @*Results@#No significant difference was observed in the Agatston score for protocols A (median, 63.05; interquartile range [IQR], 0–232.28) and C (median, 60.25; IQR, 0–195.20) (p = 0.060). The mean difference in the Agatston score for protocols A and C was relatively small (-7.82) and with the limits of agreement from -65.20 to 49.56 (ICC = 0.997). The Agatston score for protocol B (median, 34.85; IQR, 0–120.73) was significantly underestimated compared with that for protocol A (p < 0.001). The UHP Sn150 kVp mode facilitated an effective radiation dose reduction by approximately 30% (0.58 vs. 0.82 mSv, p < 0.001) from that associated with the standard 120 kVp mode. @*Conclusion@#The Agatston scores for CACS with the UHP Sn150 kVp mode with a kVp-independent reconstruction algorithm and the standard 120 kVp demonstrated excellent agreement with a small mean difference and narrow agreement limits. The UHP Sn150 kVp mode allowed a significant reduction in the radiation dose.