Rationale and Objectives
This study evaluated the altered regional cerebral blood flow (rCBF) in resting state in patients with acute posttraumatic stress disorder (PTSD) 3 months after trauma.
Materials and Methods
The rCBF was measured in 30 patients with acute PTSD and 36 healthy controls.
Results
Survivors with acute PTSD showed decreased rCBF, the Clinician-Administered PTSD Scale score correlated negatively with the rCBF, and rCBF at resting state decreased in acute PTSD.
Conclusions
PTSD symptom severity was associated with diminished cerebral blood flow in the right insular cortex and right orbital medial frontal gyrus. The rCBF may predict PTSD symptom severity.
Introduction
Posttraumatic stress disorder (PTSD) is a condition that develops from a sudden, life-threatening, or catastrophic event causing delayed emergence and long-term persistence of mental disorders. Patients experience mental disorders in various ways, including intrusive memories, disturbing recollections, nightmares, flashbacks, distress, and physiological reactions on exposure to reminders of the traumatic event. These disorders seriously affect the patients’ quality of life.
Many functional imaging studies have been performed in patients with chronic PTSD. For example, Semple et al. found increased regional cerebral blood flow (rCBF) in the right amygdala, left parahippocampal gyrus, and occipital cortex when patients performed an auditory continuous performance task. Further, patients with PTSD showed decreased frontal cortex and anterior cingulate activity compared to healthy controls. In a similar study, the researchers found a significantly increased rCBF in the orbitofrontal cortex and a reduced left/right hippocampal perfusion ratio in the PTSD group . The subjects in the foregoing studies included veterans with combat-related PTSD and a history of substance abuse, associated with major effects on brain structure and function . Indeed, many patients with PTSD are often heavily medicated or have current or past alcohol and substance abuse issues .
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Materials and Methods
Subjects
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Imaging Data Acquisition
Structural MRI Data
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Perfusion Data
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Image Processing
Structural MRI Data
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Perfusion Data
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Smoothing
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Masking
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ROI Generation
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Statistical Analyses
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Results
Patient Demographics
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Table 1
Demographics of Physically Healthy Trauma Survivors and Normal Controls
Characteristics PTSD ( n = 30) NC ( n = 36)P Sex, n (%) 13:17 16:20 0.90 Female 13(43) 16(44) Male 17(57) 20(56) Mean age (y) 33.3 ± 9.8 34.4 ± 7.8 0.57 Mean education (y) 7.6 ± 2.2 10.5 ± 1.3 0.01 \* Days after trauma 91.5 ± 1.1 CAPS Mean 49.9 ± 27.4 Female 34.021.8 Male 26.3 ± 15.9 Ethnicity Han (Chinese) Han (Chinese)
CAPS, Clinician-Administered PTSD Scale; NC, normal controls; PTSD, posttraumatic stress disorder.
Data are presented as mean ± SD. Age and gender had no significant difference between subjects with PTSD and healthy controls by independent t tests analysis of covariance (ANCOVA) ( P > 0.05).
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Table 2
Decreased rCBF in Various Brain Regions of Patients with PTSD
Regions Mean ± SD in mL/100 g/min Talairach_T__Z_ PTSD ( n = 30) HC ( n = 36) x yy zz R TL 55.877 ± 3.043 107.793 ± 19.020 58 32 2 4.72 4.34 MFG 53.062 ± 8.963 66.450 ± 15.719 28 44 34 4.54 4.19 OMFG 55.666 ± 3.267 85.186 ± 19.068 4 46 −2 4.20 3.92 INS 56.085 ± 2.991 138.226 ± 22.917 36 −10 10 5.24 4.73 MOG 58.097 ± 3.351 96.672 ± 15.239 48 −74 24 5.40 4.85 Pcu 60.466 ± 3.899 123.065 ± 18.058 4 −72 44 4.26 3.97 L TL 33.605 ± 2.810 59.331 ± 10.512 −66 −18 −14 4.22 3.93
INS, insula; L, left; MFG, middle frontal gyrus; MOG, middle occipital gyrus; OMFG, orbital medial frontal gyrus; Pcu, precuneus; R, right; TL, temporal lobe.
Group comparisons were performed by analysis of two-sample t tests in SPM5 with the PTSD group as a fixed factor and age and gender as covariates. The results were compared to a threshold using a false discovery rate (FDR)–corrected P value < 0.05.
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Correlation of Symptom Severity with Perfusion
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Table 3
Correlation Between rCBF Values and CAPS Score
Regions CAPS r_P_ R TL 0.027 0.886 MFG 0.132 0.488 OMFG −0.231 \* 0.219 \* INS −0.396 \* 0.030 \* MOG 0.040 0.832 Pcu 0.112 0.556 L TL 0.312 0.094
INS, insula; L, left; MFG, middle frontal gyrus; MOG, middle occipital gyrus; OMFG, orbital medial frontal gyrus; Pcu, precuneus; R, right; TL, temporal lobe.
Region of in (ROI)-based correlational analysis was performed using Pearson partial correlation analysis. Age and gender were treated as controlling covariates. Significance levels were set at P < 0.05.
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Discussion
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Conclusions
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Acknowledgments
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