title: Neuroimaging-aided differential diagnosis of the depressive state.
abstract: A serious problem in psychiatric practice is the lack of specific, objective biomarker-based assessments to guide diagnosis and treatment. The use of such biomarkers could assist clinicians in establishing differential diagnosis, which may improve specific individualised treatment. This multi-site study sought to develop a clinically suitable neuroimaging-guided diagnostic support system for differential diagnosis at the single-subject level among multiple psychiatric disorders with depressive symptoms using near-infrared spectroscopy, which is a compact and portable neuroimaging method. We conducted a multi-site, case-control replication study using two cohorts, which included seven hospitals in Japan. The study included 673 patients (women/men: 315/358) with psychiatric disorders (major depressive disorder, bipolar disorder, or schizophrenia) who manifested depressive symptoms, and 1007 healthy volunteers (530/477). We measured the accuracy of the single-subject classification in differential diagnosis among major psychiatric disorders, based on spatiotemporal characteristics of fronto-temporal cortical haemodynamic response patterns induced by a brief (<3 min) verbal fluency task. Data from the initial site were used to determine an optimal threshold, based on receiver-operator characteristics analysis, and to generate the simplest and most significant algorithm, which was validated using data from the remaining six sites. The frontal haemodynamic patterns detected by the near-infrared spectroscopy method accurately distinguished between patients with major depressive disorder (74.6%) and those with the two other disorders (85.5%; bipolar disorder or schizophrenia) that presented with depressive symptoms. These results suggest that neuroimaging-guided differential diagnosis of major psychiatric disorders developed using the near-infrared spectroscopy method can be a promising biomarker that should aid in personalised care in real clinical settings. Potential confounding effects of clinical (e.g., age, sex) and systemic (e.g., autonomic nervous system indices) variables on brain signals will need to be clarified to improve classification accuracy.
authors.affiliation: Department of Neuropsychiatry, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Takizawa
authors.forename: Masato
authors.initials: M
authors.lastname: Fukuda
authors.forename: Shingo
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Kiyoto
authors.initials: K
authors.lastname: Kasai
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.forename: Shenghong
authors.initials: S
authors.lastname: Pu
authors.forename: Takamasa
authors.initials: T
authors.lastname: Noda
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Niwa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okazaki
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000465:Algorithms; D001714:Bipolar Disorder / Q000175:diagnosis / Q000473:pathology; D001931:Brain Mapping; D002560:Cerebrovascular Circulation / Q000502:physiology; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000175:diagnosis* / Q000473:pathology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006454:Hemoglobins / Q000032:analysis / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000473:pathology; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000175:diagnosis / Q000473:pathology; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013702:Temporal Lobe / Q000473:pathology
chemical_list: D006454:Hemoglobins
keywords: Depressive state; Differential diagnosis; Near-infrared spectroscopy (NIRS); Neuroimaging; Psychiatric disorder