Abstract
Disrupted white matter (WM) integrity in the anterior thalamic radiation (ATR) has been identified in individuals with bipolar disorder (BD). We explored whether structural WM aberration in the ATR could be visually evaluated by diffusion tensor tractography (DTT). The study comprised 114 participants, including 57 patients with BD and 57 healthy controls (HCs). A poorly visualized ATR reflects an abnormal WM structure. We defined a poorly visualized ATR as one in which at least one ATR fiber bundle failed to reach to the boundary between gray and white matter. Poor ATR visualization occurred significantly more frequently in the left ATR of those with BD than in HCs (P = 0.042). Furthermore, we adjusted the fractional anisotropy (FA) value and when evaluation of a given ATR changed from good to poor, we defined that value as the optimal FA threshold. In the right ATR, we successfully classified BD and HCs with 71.1% accuracy (sensitivity = 89.5% and specificity = 52.6%) and an area under the curve of 0.76 using the optimal FA threshold of 0.28. The present results suggest that the optimal FA threshold can serve as a biological marker that distinguishes individuals with BD from HCs. Thus, visual evaluation of the ATR by DTT may prove to be a useful adjunctive diagnostic tool for BD in clinical practice.
Highlights
Bipolar disorder (BD) is a chronic mental disorder (1–2% in general population) associated with high rates of non-recovery, psychiatric and medical comorbidity, and progressive cognitive deterioration [1]
The proportion of participants with good visualization of the left anterior thalamic radiation (ATR) was significantly smaller in the BD group than in healthy controls (HCs) group (P = 0.04), whereas no such significant difference was found for visualization of the right ATR (P = 0.15) (Table 3)
The current findings indicate that visual evaluation using diffusion tensor tractography (DTT) might be more sensitive than the conventional procedure for investigating white matter (WM) aberrations of the ATR in people with BD
Summary
Bipolar disorder (BD) is a chronic mental disorder (1–2% in general population) associated with high rates of non-recovery, psychiatric and medical comorbidity, and progressive cognitive deterioration (especially in attention and executive function) [1]. A growing number of neuroimaging studies have revealed that frontal-limbic neuronal networks may play an important role in cognitive and emotional processing in BD [2]. Diffusion tensor imaging (DTI) is a technique used to examine connectivity in the brain, and studies have identified atypical structural connectivity in individuals with BD [3]. Studies have consistently reported that BD is associated with lower fractional anisotropy (FA) values in this tract, which may be related to negative feelings such as sadness [4,5,6]. Most DTI studies using fiber tractography have a drawback. Because they usually average DTI parameter values across all voxels within a described WM fiber bundle and compare them between groups, in studies of BD, fine
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