title: A longitudinal fMRI investigation in acute post-traumatic stress disorder (PTSD).
abstract: Background Neuroimaging studies have implicated limbic, paralimbic, and prefrontal cortex in the pathophysiology of chronic post-traumatic stress disorder (PTSD). However, little is known about the neural substrates of acute PTSD and how they change with symptom improvement. Purpose To examine the neural circuitry underlying acute PTSD and brain function changes during clinical recovery from this disorder. Material and Methods Nineteen acute PTSD patients and nine non-PTSD subjects who all experienced a devastating mining accident underwent clinical assessment as well as functional magnetic resonance imaging (fMRI) scanning while viewing trauma-related and neutral pictures. Two years after the accident, a subgroup of 17 patients completed a second clinical evaluation, of which 13 were given an identical follow-up scan. Results Acute PTSD patients demonstrated greater activation in the vermis and right posterior cingulate, and greater deactivation in the bilateral medial prefrontal cortex and inferior parietal lobules than controls in the traumatic versus neutral condition. At follow-up, PTSD patients showed symptom reduction and decreased activation in the right middle frontal gyrus, bilateral posterior cingulate/precuneus, and cerebellum. Correlation results confirmed these findings and indicated that brain activation in the posterior cingulate/precuneus and vermis was predictive of PTSD symptom improvement. Conclusion The findings support the involvement of the medial prefrontal cortex, inferior parietal lobule, posterior cingulate, and vermis in the pathogenesis of acute PTSD. Brain activation in the vermis and posterior cingulate/precuneus appears to be a biological marker of recovery potential from PTSD. Furthermore, decreased activation of the middle frontal gyrus, posterior cingulate/precuneus, and cerebellum may reflect symptom improvement.
authors.affiliation: 1 Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ke
authors.affiliation: 2 Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, PR China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: 1 Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.
authors.forename: Rongfeng
authors.initials: R
authors.lastname: Qi
authors.affiliation: 2 Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, PR China.
authors.forename: Weihui
authors.initials: W
authors.lastname: Li
authors.affiliation: 3 Guangdong Academy of Medical Science, Guangdong General Hospital, Guangdong Mental Health Center, Guangzhou, PR China.
authors.forename: Cailan
authors.initials: C
authors.lastname: Hou
authors.affiliation: 1 Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: 4 Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, PR China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: He
authors.affiliation: 2 Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, PR China.|5 Shenzhen Kangning Hospital of Guangdong Province, Shenzhen, PR China.
authors.forename: Lingjiang
authors.initials: L
authors.lastname: Li
authors.affiliation: 1 Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.
authors.forename: Guangming
authors.initials: G
authors.lastname: Lu
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020127:Recovery of Function; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: Post-traumatic stress disorder (PTSD); functional magnetic resonance imaging (fMRI); longitudinal; medial prefrontal cortex; symptom provocation