Electroconvulsive therapy (ECT) is the most effective treatment for a depressive episode but the mechanism of action and neural correlates of response are poorly understood. Different theories have suggested that anticonvulsant properties or neurotrophic effects are related to the unique mechanism of action of ECT. This review assessed longitudinal imaging investigations (both structural and functional) associated with ECT response published from 2002 to August 2013. We identified 26 investigations that used a variety of different imaging modalities and data analysis methods. Despite these methodological differences, we summarized the major findings of each investigation and identified common patterns that exist across multiple investigations. The ECT response is associated with decreased frontal perfusion, metabolism, and functional connectivity and increased volume and neuronal chemical metabolites. The general collective of longitudinal neuroimaging investigations support both the anticonvulsant and the neurotrophic effects of ECT. We propose a conceptual framework that integrates these seemingly contradictory hypotheses.
Purpose The purpose of this study was to determine the reproducibility and reliability of glutamine, measured with a very short echo time phase rotation stimulated echo acquisition mode (VTE-PR STEAM) sequence at 3 Tesla, in subjects with schizophrenia. Methods Seven subjects with schizophrenia were scanned twice with VTE-PR STEAM in a Siemens 3T TIM Trio with a 32 channel head coil. Spectroscopic data was collected from two voxels in grey matter, one in the dorsal anterior cingulate and the other in the medial occipital cortex. Reproducibility was assessed using the coefficients of variation (CV) and reliability with standard error of measurement (SEM) and intra-class correlations (ICC). Phantoms containing increasing concentrations of glutamine in a physiologic solution of other neuro-metabolites with overlapping resonances, were scanned to assess the validity of spectral glutamine measurement. Results Very good reliability and reproducibility for glutamine in both regions of interest were supported by CVs ≤ 10.0% and ICCs of ≥0.6, respectively. Phantom studies documented a robust correspondence between known glutamine concentrations and VTE-PR STEAM measurements of this metabolite (R2= 0.988). Conclusion The VTE-PR STEAM approach at 3 Tesla permits the longitudinal assessment of glutamine and other 1H-MRS neuro-metabolites in a clinically plausible setting.
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