title: Predictive value of brain perfusion SPECT for rTMS response in pharmacoresistant depression.
abstract: OBJECTIVE
  The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression.
  
  
  METHODS
  Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of (99m)Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p < 0.001, uncorrected).
  
  
  RESULTS
  Of the patients, 18 (54.5%) were responders to rTMS and 15 were non-responders (45.5%). There were no statistically significant differences in demographic and clinical characteristics (p > 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively.
  
  
  CONCLUSIONS
  This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features.
authors.affiliation: Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France.
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Richieri
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
authors.forename: Jean
authors.initials: J
authors.lastname: Farisse
authors.forename: Cecile
authors.initials: C
authors.lastname: Colavolpe
authors.forename: Olivier
authors.initials: O
authors.lastname: Mundler
authors.forename: Christophe
authors.initials: C
authors.lastname: Lancon
authors.forename: Eric
authors.initials: E
authors.lastname: Guedj
mesh_terms: D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D003545:Cysteine / Q000031:analogs & derivatives; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D055420:Perfusion Imaging; D011237:Predictive Value of Tests; D012372:ROC Curve; D015899:Tomography, Emission-Computed, Single-Photon; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
chemical_list: D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine