title: Anterior cingulate cortex choline levels in female adolescents with unipolar versus bipolar depression: a potential new tool for diagnosis.
abstract: BACKGROUND
  Delayed diagnosis in bipolar disorder (BD) due to misdiagnosis as major depressive disorder (MDD) is a significant public health concern. Thus, identification of relevant diagnostic biomarkers is a critical unmet need, particularly early in the course of illness. The anterior cingulate cortex (ACC) is thought to play an important role in mood disorder pathophysiology. Case-control studies utilizing proton-1 magnetic resonance spectroscopy ((1)H-MRS) have found increased total choline levels in several brain regions in MDD. However, there are no published (1)H-MRS reports directly comparing adolescents with MDD and BD. We hypothesized that ACC choline levels would be increased in adolescents with unipolar versus bipolar depression.
  
  
  METHODS
  We studied depressed adolescents with MDD (n=28; mean age 17.0±2.1 years) and BD (n=9; 17.3±3.1 years). A Siemens Verio 3-Tesla clinical MRI system was used to acquire scans, using a single-voxel PRESS sequence. The voxel (18.75 cm(3)) was positioned on the ACC in the midsagittal plane. To remove potential gender effects, only female adolescent participants were included. Data were analyzed using the ANOVA and post-hoc Tukey tests.
  
  
  RESULTS
  A significantly increased ACC choline/creatine ratio was observed in participants with MDD (mean=0.253±0.021) compared to BD (mean=0.219±0.020) (p=0.0002). There were no significant differences in the other (1)H-MRS metabolites.
  
  
  CONCLUSIONS
  Cross sectional design, single gender sample, limited sample size.
  
  
  CONCLUSIONS
  The present findings suggest that ACC total choline may have the potential to serve as a diagnostic biomarker in adolescent mood disorders.
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA. Electronic address: Xianfeng.Shi@hsc.utah.edu.
authors.forename: Xian-Feng
authors.initials: XF
authors.lastname: Shi
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Forrest
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
authors.forename: M Danielle
authors.initials: MD
authors.lastname: Kuykendall
authors.affiliation: Department of Radiology, University of Utah, School of Medicine, Salt Lake City, UT, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Prescot
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Sung
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
authors.forename: Rebekah S
authors.initials: RS
authors.lastname: Huber
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Hellem
authors.affiliation: Department of Radiology, University of Utah, School of Medicine, Salt Lake City, UT, USA.
authors.forename: Eun-Kee
authors.initials: EK
authors.lastname: Jeong
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA; VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
authors.forename: Perry F
authors.initials: PF
authors.lastname: Renshaw
authors.affiliation: The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA; VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Kondo
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000175:diagnosis / Q000378:metabolism*; D002794:Choline / Q000378:metabolism*; D003401:Creatine / Q000378:metabolism; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000378:metabolism*; D005260:Female; D006179:Gyrus Cinguli / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D018401:Sample Size; D055815:Young Adult
chemical_list: D003401:Creatine; D002794:Choline
keywords: Biomarker; Bipolar; Diagnosis; Neuroimaging; Spectroscopy; Unipolar
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