title: Regional homogeneity of resting-state brain abnormalities in bipolar and unipolar depression.
abstract: OBJECTIVE
  Bipolar disorder patients experiencing a depressive episode (BD-dep) without an observed history of mania are often misdiagnosed and are consequently treated as having unipolar depression (UD), leading to inadequate treatment and poor outcomes. An essential solution to this problem is to identify objective biological markers that distinguish BD-dep and UD patients at an early stage. However, studies directly comparing the brain dysfunctions associated with BD-dep and UD are rare. More importantly, the specificity of the differences in brain activity between these mental disorders has not been examined. With whole-brain regional homogeneity analysis and region-of-interest (ROI) based receiver operating characteristic (ROC) analysis, we aimed to compare the resting-state brain activity of BD-dep and UD patients. Furthermore, we examined the specific differences and whether these differences were attributed to the brain abnormality caused by BD-dep, UD, or both.
  
  
  METHODS
  Twenty-one bipolar and 21 unipolar depressed patients, as well as 26 healthy subjects matched for gender, age, and educational levels, participated in the study. We compared the differences in the regional homogeneity (ReHo) of the BD-dep and UD groups and further identified their pathophysiological abnormality. In the brain regions showing a difference between the BD-dep and UD groups, we further conducted receptive operation characteristic (ROC) analyses to confirm the effectiveness of the identified difference in classifying the patients.
  
  
  RESULTS
  We observed ReHo differences between the BD-dep and UD groups in the right ventrolateral middle frontal gyrus, right dorsal anterior insular, right ventral anterior insular, right cerebellum posterior gyrus, right posterior cingulate cortex, right parahippocampal gyrus, and left cerebellum anterior gyrus. Further ROI comparisons and ROC analysis on these ROIs showed that the right parahippocampal gyrus reflected abnormality specific to the BD-dep group, while the right middle frontal gyrus, the right dorsal anterior insular, the right cerebellum posterior gyrus, and the right posterior cingulate cortex showed abnormality specific to the UD group.
  
  
  CONCLUSIONS
  We found brain regions showing resting state ReHo differences and examined their sensitivity and specificity, suggesting a potential neuroimaging biomarker to distinguish between BD-dep and UD patients. We further clarified the pathophysiological abnormality of these regions for each of the two patient populations.
authors.affiliation: Department of Radiology, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
authors.forename: Chun-Hong
authors.initials: CH
authors.lastname: Liu
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.forename: Xia
authors.initials: X
authors.lastname: Wu
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Fu-Chun
authors.initials: FC
authors.lastname: Zhou
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.forename: Chang-Le
authors.initials: CL
authors.lastname: Tie
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Wang
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yang
authors.forename: Chuan-Yue
authors.initials: CY
authors.lastname: Wang
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000503:physiopathology*; D003866:Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012146:Rest / Q000502:physiology*; D055815:Young Adult