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Depressive Psychosis: Clinical Usefulness of MR Spectroscopy Data in Predicting Prognosis¹

¹ From the Department of Radiology (H. Kado, I.K.), and Department of Neuropsychiatry and Neurology (K.N.), Akita Research Institute for Brain and Blood Vessels, 6-10 Kubotamachi, Sensyu, Akita 010-0874, Japan; and Departments of Radiology (H. Kimura) and Neuropsychiatry (T.M.), Fukui University, Fukui, Japan. Received August 11, 2004; revision requested October 21; revision received January 13, 2005; accepted February 16; final version accepted March 11. Address correspondence to H. Kado.

Purpose: To prospectively assess the usefulness of magnetic resonance (MR) spectroscopy data acquired before the initiation of medical therapy in predicting prognosis in patients with depressive psychosis.

Materials and Methods: All subjects gave written informed consent to an institutional committee for clinical research–approved study protocol. The clinical course after medication in 52 patients with depressive psychosis (age range, 52–78 years; 21 men, 31 women) was investigated. In all patients, MR spectroscopy was performed with a 1.5-T MR imaging unit before the initiation of medical therapy. Cerebrovascular lesions (CVLs), which appear as high-signal-intensity areas on T2-weighted MR images, were evaluated by using the Fazekas rating scale. Patients were classified into two groups on the basis of the ratio of N-acetylaspartate (NAA) to creatine and phosphocreatine (Cr): Patients in group A had an NAA/Cr ratio greater than 1.91, and patients in group B had an NAA/Cr ratio of 1.91 or less. To assess the response of the patients to medication, standard psychiatric tests—the Verbal Associative Fluency Test (VAFT), the Digit Symbol Test (DST), the Mini-Mental State Examination (MMSE), and the Hamilton Depression Rating Scale (HAM-D)—were administered before and after medical therapy was initiated. Mean test scores before and after medication were compared with paired t testing. P < .05 was considered to indicate a significant difference.

Results: There were 25 patients in group A and 27 in group B. In group A, the mean VAFT and DST scores increased and the mean HAM-D score decreased after medication. There was no significant difference in mean MMSE scores before and after medication (P = .945 for group A and P = .934 for group B). In group B, there were no significant differences in any of the psychiatric test scores before and after medication. The high-signal-intensity area score in group B was significantly higher than that in group A (P = .004).

Conclusion: MR spectroscopy data obtained before the initiation of medical therapy were useful in predicting prognosis in patients with depressive psychosis; this suggests that the combined burden of all CVLs may affect the response to antidepressant medication.

© RSNA, 2006