Şizofrenide difüzyon tensör görüntüleme (DTG) bulguları: Eleştirel bir gözden geçirme

Amaç: Difüzyon Tensör Görüntüleme (DTG) son dönemde şizofreni hastalarında beynin değişik bölgelerini inceleme amacıyla kullanılmaya başlanan bir ak madde yapısını araştırma yöntemidir. Bu çalışmanın amacı günümüze kadar şizofreni hastaları üzerinde bu yöntemle yapılmış çalışmaların sonuçlarını eleştirel bir biçimde gözden geçirmektir, yöntem: Şizofrenide D TG çalışmaları için PubMed elektronik veri tabanı taranıp sonuçlar gözden geçirilmiştir. Sonuçlar: Sayıları az olmasına karşın, günümüze kadar şizofreni üzerinde yapılmış D TG çalışmaları bu hastalıkta ak madde anormallikleri üzerine yoğunlaşmıştır. Tartışma: Ak madde anormalliklerinin yaygın mı, bölgesel mü birincil mi; yoksa gri madde anormalliklerine ikincil mi olduğu bilinmemektedir. Şizofrenide D TG bulguları nöropsikolojik ölçeklerle ilişkili bulunmuştur. DTG verileri üzerinde ilaç tedavisinin etkisi yeterince belirlenmemiştir. Daha objektif dışlama ölçütleri, daha çok sayıda hasta ile ve her iki cinsiyetten uzunlamasına örneklemlerle yapılmış çalışmalar gerekmektedir. Bu sınırlılıklara rağmen DTG' nin canlılar üzerinde ak madde değişikliklerinin görüntülemesi için güçlü bir yöntem olduğu kanısına varılmıştır.

Diffusion tensor imaging (DTI) findings in schizophrenia: a critical review

Objective: Diffusion tensor imaging (DTI) is a tool for examining the white matter'microstructure, which recently found use for imaging of variable regions of the-brain in schizophrenic patients. The objective of this study is to critically review the findings of studies done on schizophrenia patients. Methods: PubMed electronic database was searched for DTI studies in schizophrenia and the results reviewed. Results: Although few in number; DTI studies done up to date on schizophrenia provide concentrate on abnormalities in white matter in schizophrenia. Discussion: It is not known whether abnormalities of white matter are widespread or localised; and primary or secondary to abnormalities of gray matter. The DTI measures correlate with neuropsychological measures in schizophrenia. The effect of drug treatment on DTI variables is inadequately identified. Studies using more objective exclusion criteria, larger populations from both genders and a prospective design are required. Despite these limitations our opinion is that DTI is a powerful imaging tool for the study of white matter changes in vivo.

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  • 1. Horsfield MA, Jones DK. Applications of diffusion weighted and diffusion tensor MRI to white matter diseases-a review. NMR Biomed 2002; 15:570-577.
  • 2. Taber KH, Pierpaoli C, Rose SE, Rugg-Gunn FJ, Chalk JB, Jones DK ve ark. The future for diffusion tensor imaging in neuropsychiatry. J Neuropsychiatry Clin Neurosci 2002; 14:1-5.
  • 3. Taber KH, Hurley RA. The role for diffusion tensor imaging in neuropsychiatry. Curr Opin Psychiatry 2003; 16:341-347.
  • 4. Barkovich AJ. Pediatric Neuroimaging. Üçüncü baskı, Philadelphia, Lippincott Williams and Wilkins, 2000. 5. Lim KO, Helpern JA. Neuropsychiatric applications of DTI- a review. NMR Biomed 2002; 15:587-593.
  • 6. Taylor WD, Hsu E, Ranga Rama Krishnan K, MacFall JR. Diffusion tensor imaging: background, potential, and utility in psychiatric research. Biol Psychiatry 2004; 55:201-207.
  • 7. Minami T, Nobuhara K, Okugawa G, Takase K, Yoshida T, Sawada S ve ark. Diffusion tensor magnetic resonance imaging of disruption of regional white matter in schizophrenia. Neuropsychobiol 2003; 47:141-145.
  • 8. Okugawa G, Nobuhara K, Minami T, Tamagaki C, Takase K, Sugimoto T ve ark. Subtle disruption of the middle cerebellar peduncles in patients with schizophrenia. Neuropsychobiol 2004; 50:119-123.
  • 9. Kaplan HI, Sadock BJ. Pocket Handbook of Psychiatric Drug Treatment. İkinci baskı, Baltimore, Williams and Wilkins, 1996.
  • 10. Agartz I, Andersson JLR, Skare S. Abnormal brain white matter in schizophrenia: a diffusion tensor imaging study. NeuroReport 2001; 12:2251-2254.
  • 11. Ardekani BA, Nierenberg J, Hoptman MJ, Javitt DC, Lim KO. MRI study of white matter diffusion anisotropy in schizophrenia. NeuroReport 2003; 14:2025-2029.
  • 12. Foong J, Symms MR, Barker GJ, Maier M, Miller DH, Ron MA. Investigating regional white matter in schizophrenia using diffusion tensor imaging. NeuroReport 2002; 13:333-336.
  • 13. Hoptman MJ, Volavka J, Johnson G, Weiss E, Bilder RM, Lim KO. Frontal white matter microstructure, aggression, and impulsivity in men with schizophrenia: a preliminary study. Biol Psychiatry 2002;52:9-14.
  • 14. Hubl D, Koenig T, Strik W, Federspiel A, Kreis R, Boesch C ve ark. Pathways that make voices: white matter changes in auditory hallucinations. Arch Gen Psychiatry 2004; 61:658-668.
  • 15. Kumra S, Ashtari M, McMeniman M, Vogel J, Augustin R, Becker DE ve ark. Reduced frontal white matter integrity in early-onset schizophrenia: a preliminary study. Biol Psychiatry 2004; 55:1138-1145.
  • 16. Lim KO, Hedehus M, Moseley M, de Crespigny A, Sullivan E, Pfefferbaum A. Compromised white matter tract integrity in schizophrenia inferred from diffusion tensor imaging. Arch Gen Psychiatry 1999; 56:367-374.
  • 17. Pütz B, Auer DP. Assessment of brain connectivity in schizophrenics and healthy subjects with diffusion tensor imaging. Neuroimage 2000; 11(Suppl.2):205.
  • 18. Steel RM, Bastin ME, McConnell S, Marshall I, Cunningham-Owens DG, Lawrie SM ve ark. Diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (¹H MRS) in schizophrenic subjects and normal controls. Psychiat Res 2001; 106:161-170.
  • 19. Wolkin A, Choi SJ, Szilagyi S, Sanfilipo M, Rotrosen JP, Lim KO. Inferior frontal white matter anisotropy and negative symptoms of schizophrenia: a diffusion tensor imaging study. Am J Psychiatry 2003; 160:572-574.
  • 20. Foong J, Maier M, Clark CA, Barker GJ, Miller DH, Ron MA. Neuropathological abnormalities of the corpus callosum in schizophrenia: a diffusion tensor imaging study. J Neurol Neurosurg Psychiatry 2000; 68:242-244.
  • 21. Wang F, Sun Z, Du X, Wang X, Cong Z, Zhang H ve ark. A diffusion tensor imaging study of middle and superior cerebellar peduncle in male patients with schizophrenia. Neurosci Lett 2003; 348:135-138.
  • 22. Burns J, Job D, Bastin ME, Whalley H, Macgillivray T, Johnstone EC ve ark. Structural disconnectivity in schizophrenia: a diffusion tensor magnetic resonance imaging study. Br J Psychiatry 2003; 182:439-443.
  • 23. Kubicki M, Westin C-F, Maier SE, Frumin M, Nestor PG, Salisbury DF ve ark. Uncinate fasciculus findings in schizophrenia: a magnetic resonance diffusion tensor imaging study. Am J Psychiatry 2002; 159:813-820.
  • 24. Kubicki M, Westin C-F, Nestor PG, Wible CG, Frumin M, Maier SE ve ark. Cingulate fasciculus integrity disruption in schizophrenia: a magnetic resonance diffusion tensor imaging study. Biol Psychiatry 2003; 54:1171-1180.
  • 25. Sun Z, Wang F, Cui L, Breeze J, Du X, Wang X ve ark. Abnormal anterior cingulum in patients with schizophrenia: a diffusion tensor imaging study. Neuro Report 2003; 14:1833-1836.
  • 26. Wang F, Sun Z, Cui L, Du X, Wang X, Zhang H ve ark. Anterior cingulum abnormalities in male patients with schizophrenia determined through diffusion tensor imaging. Am J Psychiatry 2004; 161:573-575.
  • 27. Begré S, Federspiel A, Kiefer C, Schroth G, Dierks T, Strik WK. Reduced hippocampal anisotropy related to anteriorization of alpha EEG in schizophrenia. Neuro Report 2003; 14:739-742.
  • 28. Kalus P, Buri C, Slotboom J, Gralla J, Remonda L, Dierks T ve ark. Volumetry and diffusion tensor imaging of hippocampal subregions in schizophrenia. Neuro Report 2004; 15:867-871.
  • 29. Buchanan RW, Carpenter WT. Schizophrenia: introduction and overview. BJ Sadock, VA Sadock (eds): Comprehensive Textbook of Psychiatry’de. Yedinci baskı, Philadelphia, Lippincott Williams and Wilkins, 2000, s.1100-1102.
  • 30. Mueser KT, McGurk SR. Schizophrenia. Lancet 2004; 363:2063-2072.
  • 31. Pesold C, Roberts RC, Kirkpatrick B. Neuroscience of schizophrenia. J Panksepp (ed): Textbook of Biological Psychiatry’de. New Jersey, Wiley-Liss, 2004, s.267-293.
  • 32. Hakak Y, Walker JR, Li C, Wong WH, Davis KL, Buxbaum JD ve ark. Genome-wide expression analysis reveals dysregulation of myelinationrelated genes in chronic schizophrenia. Proc Natl Acad Sci U S A 2001; 98:4746-4751.
  • 33. Crow TJ: Cerebral asymmetry and the lateralization of language: core deficits in schizophrenia as pointers to the gene. Curr Opin Psychiatry 2004; 17:97-106.
  • 34. Harvey PD, Sharma T. Understanding and Treating Cognition in Schizophrenia: A Clinician’s Handbook. Birinci Baskı, London, Martin Dunitz, 2002.
  • 35. Highley JR, Walker MA, Esiri MM, Crow TJ, Harrison PJ. Asymmetry of the uncinate fasciculus: a post-mortem study of normal subjects and patients with schizophrenia. Cereb Cortex 2002; 12:1218-1224.