The Research On Hippocampal Metabolism In Patients With Major Depression Disorder Based On Quantitative Magnetic Resonance Spectroscopy

Objective1.To observe whether the statistical results of patients with major depression disorder（MDD）would be affected by different quantitative methods of AMARES and QUEST,and provide a more powerful basis for the application of different quantitative methods of quantitative magnetic resonance spectroscopy（MRS）in depression.2.We used MRS to quantitatively analyze changes in hippocampal metabolism before and after treatment in patients with MDD,and to assess the relationship between hippocampal metabolite concentrations and changes in the score of the Hamilton Depression Rating Scale-17(HDRS_-17)and observe the relationship between hippocampal metabolism and treatment response in MDD patients,thus to explore whether the characteristics of abnormal hippocampal metabolites can help predict the later treatment effect of patients.Methods1.A total of 65 patients with MDD were collected,and MRS scans were performed before and after 8 weeks of antidepressant treatment.Post-processing analysis and comparison of spectral data before and after treatment in all depression patients using AMARES and QUEST two quantitative methods in jMRUI software,and the degree of depression before and after treatment were assessed by HDRS_-1717 after MRS scan.2.53 patients with MDD and 20 healthy subjects were collected in test set.All subjects underwent MRS scans at baseline after admission and applied HDRS_-17 on the day of MRS to assess the degree of depression in subjects.Subsequently,all patients underwent an 8-week standardized antidepressant treatment as prescribed by their doctors.After the treatment,they were re-examined for MRS,and at the same time they were evaluated again by the HDRS_-17（all patients were evaluated by the same physician）.Finally,all depression patients were divided into refractory depression（RD）group and non-refractory depression（n-RD）group based on two changes in HDRS scores,and statistical analysis was performed retrospectively on the three groups of data from horizontal and vertical,including chi-square test,analysis of variance,General linear model analysis（GLM）,paired t test,Pearson correlation analysis,logistic regression analysis and a receiver operating characteristic（ROC）curve analysis.Finally,another 35 age-and sex-matched MDD patients were collected in the validation set and received a baseline MRS scan 24-72 hours after admission to validate our predictive model.Results1.Before treatment,the concentrations of Cho and Ins in hippocampus of MDD patients quantified by AMARES were significantly higher than those quantified by QUEST,and the absolute concentrations of NAA,Glx,and Cr in the two algorithms were approximately the same.After treatment,the concentration of Ins quantified by AMARES was significantly higher than quantified by QUEST,while the other metabolite concentration were not significantly different between the two quantification methods.2.Compared with the QUEST quantification method,AMARES quantifies the CoA of NAA,Cho,and Ins concentration values lower,while Glx value CoV was higher,and Glx shows a greater change than other metabolite concentrations,especially when quantified using AMARES.In addition,the NAA and Cho concentration values CoV quantified by the two algorithms are consistent on both hippocampal voxels.3.Correlation analysis results:AMARES quantitative results showed that except for the changes of NAA metabolite concentration was significantly negatively correlated with the changes in HDRS scores（r=-0.616,p=0.000）,the absolute concentrations of other metabolites have no significant correlation with the changes in HDRS scores.While,utilizing QUEST,there was no significant correlation between the absolute concentration of any metabolite and the HDRS score.4.At baseline,the concentrations of Cho,NAA and Glx in the hippocampus of depressed patients were significantly lower than those of the healthy control group,while the concentrations of the metabolites Ins and Cr were not significantly different from those of the healthy control group.5.After treatment,NAA and Glx concentrations in hippocampus of RD patients were significantly lower than those in n-RD group,while Cho and Cr had no statistically significant difference between the two groups.In addition,NAA,Cho,and Glx in n-RD group reversed after treatment,all of which were higher than before treatment,while in the RD group,only Cho was higher than before treatment,and other metabolites were not statistically different than before treatment.6.Correlation analysis results:NAA and Glx levels had no significant correlation with HDRS at baseline.The change of NAA level（dNAA）before and after treatment was significantly negatively correlated with the change of HDRS score（dHDRS）（r=-0.582,p=0.000）,but the change of Glx level（dGlx）before and after treatment had no significant correlation with dHDRS.7.Logistic regression analysis（β=0.427,p=0.009,OR=1.533）and ROC curve analysis（AUC=0.823,p=0.009）showed that the baseline NAA metabolite concentration was an independent predictor of treatment response in patients with major depression,indicating that higher baseline NAA levels are predictive of better treatment outcomes.8.Prediction model verification:Compared with the actual diagnosis results after8 weeks of treatment,the diagnostic accuracy of the NAA regression predictive model is 87.31%,indicating that it can be used as a stable prediction model,and this diagnosis model has practical clinical value.Conclusion1.The statistical results of spectrum data of patients with severe depression will be affected by the quantitative method used.The results quantified by AMARRES are more stable,and the quantitative method of QUEST is more suitable for metabolite analysis with more severe overlapping peaks.2.The baseline level of NAA in patients with major depression is an important biological marker to predict its therapeutic effect.A lower baseline NAA level indicates a pooer therapeutic effect.