title: Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography.
abstract: BACKGROUND
  The study was designed to determine the mediating neuroanatomy of obsessive-compulsive disorder (OCD).
  
  
  METHODS
  The short half-life tracer oxygen 15-labeled carbon dioxide was used to allow for repeated positron emission tomographic determinations of regional cerebral blood flow on each of eight patients with OCD during a resting and a provoked (symptomatic) state.
  
  
  RESULTS
  Individually tailored provocative stimuli were successful in provoking OCD symptoms, in comparison with paired innocuous stimuli, as measured by self-report on OCD analogue scales (P = .002). Omnibus subtraction images demonstrated a statistically significant increase in relative regional cerebral blood flow during the OCD symptomatic state vs the resting state in right caudate nucleus (P < .006), left anterior cingulate cortex (P < .045), and bilateral orbitofrontal cortex (P < .008); increases in the left thalamus approached but did not reach statistical significance (P = .07).
  
  
  CONCLUSIONS
  These findings are consistent with results of previous functional neuroimaging studies and contemporary neurocircuitry models of OCD. The data further implicate orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex in the pathophysiology of OCD and in mediating OCD symptoms.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: S L
authors.initials: SL
authors.lastname: Rauch
authors.forename: M A
authors.initials: MA
authors.lastname: Jenike
authors.forename: N M
authors.initials: NM
authors.lastname: Alpert
authors.forename: L
authors.initials: L
authors.lastname: Baer
authors.forename: H C
authors.initials: HC
authors.lastname: Breiter
authors.forename: C R
authors.initials: CR
authors.lastname: Savage
authors.forename: A J
authors.initials: AJ
authors.lastname: Fischman
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002245:Carbon Dioxide; D002421:Caudate Nucleus / Q000098:blood supply; D002560:Cerebrovascular Circulation; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply; D006179:Gyrus Cinguli / Q000098:blood supply; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010104:Oxygen Radioisotopes; D013788:Thalamus / Q000098:blood supply; D014055:Tomography, Emission-Computed
chemical_list: D010104:Oxygen Radioisotopes; D002245:Carbon Dioxide