title: Metabolic imaging of bilateral anterior capsulotomy in refractory obsessive compulsive disorder: an FDG PET study.
abstract: The therapeutic benefits of bilateral capsulotomy for the treatment of refractory obsessive compulsive disorder (OCD) are probably attributed to interruption of the cortico-striato-thalamo-cortical circuitry. We evaluated resting brain metabolism and treatment response in OCD patients using positron emission tomography (PET) imaging. [(18)F]-fluoro-deoxy-glucose PET was performed in eight OCD patients precapsulotomy and postcapsulotomy. We determined metabolic differences between preoperative images in patients and those in eight age-matched healthy volunteers, and postoperative changes and clinical correlations in the patients. The OCD patients showed widespread metabolic increases in normalized glucose metabolism in the bilateral orbitofrontal cortex and inferior frontal gyrus, cingulate gyrus, and bilateral pons/cerebellum, and metabolic decreases bilaterally in the precentral and lingual gyri. Bilateral capsulotomy resulted in significant metabolic decreases bilaterally in the prefrontal cortical regions, especially in the dorsal anterior cingulate cortex (ACC) and in the medial dorsal thalamus and caudate nucleus. In contrast, metabolism increased bilaterally in the precentral and lingual gyri. Clinical improvement in patients correlated with metabolic changes in the bilateral dorsal ACC and in the right middle occipital gyrus after capsulotomy. This study underscores the importance of the internal capsule in modulating ventral prefrontal and dorsal anterior cingulate neuronal activity in the neurosurgical management of OCD patients.
authors: Department of Nuclear Medicine, PET Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China. zuoct_cn2000@126.com
authors: ChuanTao
authors: C
authors: Zuo
authors: Yilong
authors: Y
authors: Ma
authors: BoMin
authors: B
authors: Sun
authors: Shichun
authors: S
authors: Peng
authors: HuiWei
authors: H
authors: Zhang
authors: David
authors: D
authors: Eidelberg
authors: YiHui
authors: Y
authors: Guan
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006179:Gyrus Cinguli / Q000098:blood supply / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D020772:Internal Capsule / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18; D005947:Glucose