Abstract
New technologies are offering increasingly powerful means to obtain structural, chemical,
and functional images of the brain during life, often without the use of ionizing
radiation. Bipolar disorder, with its clear physiologic features, would appear to
be a prime candidate for the application of current brain imaging; however, only a
modest number of studies have been reported to date, and most studies have small sample
sizes and heterogeneous subject groups. Nonetheless, there are a few consistent findings
among these studies, including the following: 1) Structural imaging studies suggest an increased number of white matter hyperintensities in patients
with bipolar disorder. These may be lesions unique to bipolar disorder and its treatment,
or related to cardiovascular risk factors, which are more common in bipolar patients.
Decreased cerebellar size and anomalies of cerebellar blood volume have also been
reported. Increased sulcal prominence and enlargement of the lateral and third ventricles
are less consistently observed findings. 2) Spectroscopic imaging suggests abnormalities of metabolism of choline-containing compounds in symptomatically
ill bipolar patients and, possibly, treatment-induced changes in choline- and myo-inositol–containing compounds. Each of these groups of metabolites serves as a component
of membrane phospholipids and cellular second-messenger cycles. 3) Metabolic and blood flow studies provide evidence for decreased activity of the prefrontal cortex (PFC) in bipolar
patients during depression. It is not clear if these changes are restricted to particular
subregions of the PFC, nor if they are reversed with mania. No single pathophysiologic
mechanism yet explains these findings, although all might be due to regional alterations
in cellular activity and metabolism or changes in cell membrane composition and turnover.
The development of imaging technologies has far outpaced their use in bipolar disorder.
The promise of future studies is great, with more powerful magnetic resonance scanners,
additional ligands for positron emission tomography and single photon emission computed
tomography imaging, and improved image generation and processing already available.
Keywords
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References
- Limbic dysfunction in schizophrenia and mania. A study using 18F-labelled fluorodeoxyglucose and positron emission tomography.Br J Psychiatry. 1996; 169: 509-516
- T2 hyperintensities in bipolar disorder.Am J Psychiatry. 1995; 152: 1139-1144
- Fluorine-18 radiolabelling, biodistribution studies and preliminary PET evaluation of a new memantine derivative for imaging the NMDA receptor.J Recept Signal Transduct Res. 1999; 19: 129-141
- The cortical serotonin2 receptors studied with positron-emission tomography and [18F]-setoperone during depressive illness and antidepressant treatment with clomipramine.Biol Psychiatry. 1999; 45: 180-186
- Basal ganglia volumes and white matter hyperintensities in patients with bipolar disorder.Am J Psychiatry. 1994; 151: 687-693
- Drugs and the treatment of psychiatric disorders.in: Hardman J.G. Limbird L.E. Molinoff P.B. Ruddon R.W. Gilman A.G. Goodman and Gilman’s The Pharmacologic Basis of Therapeutics. 9th ed. McGraw-Hill, New York1996: 431-459
- Reduction of prefrontal cortex glucose metabolism common to three types of depression.Arch Gen Psychiatry. 1989; 46: 243-250
- Functional mapping of the human visual cortex by magnetic resonance imaging.Science. 1991; 254: 716-719
- The validity of the PET/alpha-[11C]methyl-L-tryptophan method for measuring rates of serotonin synthesis in the human brain.Neuropsychopharmacology. 1999; 21: 153-157
- Neural and development actions of lithium.Cell. 1989; 59: 411-419
- In vivo quantitation of cerebral metabolite concentrations using natural abundance 13C MRS at 1.5T.J Magn Reson. 1999; 136: 219-225
- One-day protocol for imaging of the nigrostriatal dopaminergic pathway in Parkinson’s disease by [123]FPCIT SPECT.J Nucl Med. 1999; 40: 753-761
- MRI abnormalities in adolescent bipolar affective disorder.J Am Acad Child Adolesc Psychiatry. 1992; 31: 258-261
- Increase in caudate nuclei volumes of first-episode schizophrenic patients taking antipsychotic drugs.Am J Psychiatry. 1994; 151: 1430-1436
- Quantitation of dexfenfluramine/d-norfenfluramine concentration in primate brain using 19F NMR spectroscopy.Magn Reson Med. 1998; 39: 149-154
- Differences between antipsychotic drugs in persistence of brain levels and behavioral effects.Psychopharmacology. 1992; 108: 338-344
- Regional brain function, emotion and disorders of emotion.Curr Opin Neurobiol. 1999; 9: 228-234
- Abnormal frontal lobe phosphorous metabolism in bipolar disorder.Am J Psychiatry. 1995; 152: 915-918
- MRI analysis of the cerebellum in bipolar disorder.Neuropsychopharmacology. 1999; 21: 63-68
- Neuroimaging and neurobiological models of depression.Harv Rev Psychiatry. 1997; 5: 138-159
- In vivo imaging or serotonin transporters with [99mTc]TRODAT-1 nonhuman primates.Eur J Nucl Med. 1999; 26: 342-347
- PET imaging of serotonin 1A receptor binding in depression.Biol Psychiatry. 1999; 46: 1375-1387
- Neuroimaging abnormalities in the subgenual prefrontal cortex.Mol Psychiatry. 1998; 3: 220-226
- Subgenual prefrontal cortex abnormalities in mood disorders.Nature. 1997; 386: 824-827
- Positron emission tomography receptor studies in epilepsy.Rev Neurol (Paris). 1999; 155: 482-488
- Bilateral subdural collections invisible on a CT brain scan.Ulster Med J. 1995; 64: 98-100
- Subcortical hyperintensities on brain magnetic resonance imaging.J Neuropsychiatry Clin Neurosci. 1991; 3: 18-22
- Gross pathology of the cerebellum in patients diagnosed and treated as functional psychiatric disorder.J Nerv Ment Dis. 1979; 167: 585-592
- Subgenual cingulate cortex volume in first-episode psychosis.Am J Psychiatry. 1999; 156: 1091-1093
- Proton spectroscopy without water suppression.Magn Reson Med. 1998; 40: 343-347
- Statistical parametric mapping with 18F-dopa PET shows bilaterally reduced striatal and nigral dopaminergic function in early Parkinson’s disease.J Neurol Neurosurg Psychiatry. 1999; 66: 754-758
- Neuroanatomical studies of major affective disorders. A review and suggestions for further research.Br J Psychiatry. 1988; 153: 444-459
- Magnetic resonance spectroscopy in affective disorders.J Neuropsychiatry Clin Neurosci. 1998; 10: 133-147
- Phosphorus-31 magnetic resonance spectroscopy and ventricular enlargement in bipolar disorder.Psychiatry Res. 1994; 55: 41-50
- In vivo detection of GABA in human brain using a localized double-quantum filter technique.Magn Reson Med. 1997; 37: 366-371
- A review of functional neuroimaging in mood disorders.Can J Psychiatry. 1997; 42: 467-475
- Functional brain imaging, limbic function, and affective disorders.The Neuroscientist. 1996; 2: 55-65
- Using single photon emission tomography (SPECT) and positron emission tomography (PET) to trace the distribution of muscarinic acetylcholine receptor (MACHR) binding radioligands.Life Sci. 1999; 64: 511-518
- Effect of tracer metabolism on PET measurement of [11C]pyrilamine binding to histamine H1 receptors.Ann Nucl Med. 1999; 13: 101-107
- Positive correlation between reduction of handwriting area and D2 dopamine receptor occupancy during treatment with neuroleptic drugs.Psychiatry Res. 1999; 90: 31-39
- Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation.Proc Natl Acad Sci U S A. 1992; 89: 5675-5679
- Applications of dynamic susceptibility contrast magnetic resonance imaging in neuropsychiatry.Neuroimage. 1996; 4: 147-162
- Cerebellar vermis dimensions on computerized tomographic scans of schizophrenic and bipolar patients.Am J Psychiatry. 1982; 139: 667-668
- Differences in cerebellar blood volume in schizophrenic and bipolar disorder.Schizophr Res. 1999; 37: 81-89
- Broadband proton decoupling in human 31P NMR spectroscopy.NMR Biomed. 1989; 1: 177-183
- Positron emission tomographic evidence of toxic effect of MDMA (“Ecstasy”) on brain serotonin neurons in human beings.Lancet. 1998; 352: 1433-1437
- Hyperintense lesions on magnetic resonance images in bipolar disorder.Biol Psychiatry. 1999; 45: 965-971
- Simultaneous in vivo spectral editing and water suppression.NMR Biomed. 1998; 11: 266-272
- Effects of myo-inositol ingestion on human brain myo-inositol levels.Biol Psychiatry. 1999; 45: 1197-1202
- Magnetic resonance spectroscopy studies of affective disorders.in: Krishnan K.R.R. Doraiswamy P.M. Brain Imaging in Clinical Psychiatry. Marcel Decker, New York1997: 185-214
- Benzodiazepine receptor imaging in the brain.Jpn J Nucl Med. 1999; 36: 307-313
- Proton-decoupled 31P chemical shift imaging of the brain in normal volunteers.NMR Biomed. 1993; 6: 173-180
- Synthesis of an I-123 analog of A-85380 and preliminary SPECT imaging of nicotinic receptors in baboon.Nucl Med Biol. 1999; 26: 201-207
- Human cerebral acetylcholinesterase activity measured with positron emission tomography.Eur J Nucl Med. 1999; 26: 135-143
- Cerebral ventricular enlargement in young manic males.J Affect Disord. 1982; 4: 15-19
- Cortical atrophy in schizophrenia and mania.J Clin Psychiatry. 1982; 43: 439-441
- Genetics and mental disorders.Biol Psychiatry. 1999; 45: 559-573
- High spatial resolution and speed in MRSI.NMR Biomed. 1997; 10: 411-422
- Structural changes in the brain of patients with bipolar affective disorder by MRI.Prog Neuropsychopharmacol Biol Psychiatry. 1997; 21: 1323-1337
- Advances in nuclear medicine.Med Health RI. 1999; 82: 190-194
- Alterations in binding site density of dopamine transporter in the striatum, orbitofrontal cortex, and amygdala in early Parkinson’s disease.Ann Neurol. 1999; 45: 601-610
- Taurine.in: Schaffer S. Lombardini J.B. Huxtable R.J. Taurine 3 Cellular and Regulatory Mechanisms. Plenum Press, New York1998: 209-217
- In vivo D2 dopamine receptor density in psychotic and nonpsychotic patients with bipolar disorder.Arch Gen Psychiatry. 1995; 52: 471-477
- Determination of the rate of the glutamate/glutamine cycle in the human brain by in vivo 13C NMR.Proc Natl Acad Sci U S A. 1999; 96: 8235-8240
- Clinical neuroimaging in psychiatry.Harv Rev Psychiatry. 1995; 2: 297-312
- Structural brain abnormalities in the major psychoses.Psychol Bull. 1990; 108: 93-108
- Susceptibility contrast imaging of cerebral blood volume.Magn Reson Med. 1991; 22: 293-299
- Localized 1H NMR spectra of glutamate in the human brain.Magn Reson Med. 1992; 25: 94-106
- Diffusion MR imaging. Theory and applications.Neuroimaging Clin N Am. 1999; 9: 343-361
- Cerebellar degeneration following acute lithium intoxication.Rev Neurol (Paris). 1998; 154: 546-548
- 3D localized 2D NMR spectroscopy on an MRI scanner.J Magn Reson. 1995; 107: 126-137
- The cerebellar cognitive affective syndrome.Brain. 1998; 121: 561-579
- Proton magnetic resonance spectroscopy of the brain in schizophrenic and affective patients.Schizophr Res. 1992; 8: 43-49
- Quantitative diffusion-tensor anisotropy brain MR imaging.Radiology. 1999; 212: 770-784
- Effects of lithium and amphetamine on inositol metabolism in the human brain as measured by 1H and 31P MRS.Biol Psychiatry. 1999; 46: 1634-1641
- Quantification of delta-opiod receptors in human brain with N1′-([1]C]methyl) naltrindole and positron emission tomography.J Cereb Blood Flow Metab. 1999; 19: 956-966
- NAA and choline measures in the anterior cingulate of bipolar disorder patients.Biol Psychiatry. 1999; 45: 119S
- Nuclear magnetic resonance spectroscopy.Depression. 1996; 4: 14-30
- The anatomy of mood disorders—review of structural neuroimaging studies.Biol Psychiatry. 1997; 41: 86-106
- The functional neuroanatomy of mood disorders.J Psychiatr Res. 1997; 31: 393-432
- Manic-depressive and pure manic states after brain lesions.Biol Psychiatry. 1991; 29: 149-158
- Structural neuroimaging and mood disorders.Biol Psychiatry. 1998; 43: 705-712
- The human brain resonance of choline-containing compounds is similar in patients receiving lithium treatment and controls. An in vivo proton magnetic resonance spectroscopy study.Biol Psychiatry. 1992; 32: 944-952
- Psychiatric and substance abuse syndrome co-occurrence in bipolar disorder following a first psychiatric hospitalization.J Clin Psychiatry. 1998; 59: 465-471
- Structural brain abnormalities in first-episode mania.Biol Psychiatry. 1993; 33: 602-609
- MRI subcortical signal hyperintensities in mania at first hospitalization.Biol Psychiatry. 1993; 33: 204-206
- Brain elimination half-life of fluvoxamine measured by 19F magnetic resonance spectroscopy.Am J Psychiatry. 1998; 155: 380-384
- D1 dopamine receptor binding in mood disorders measured by positron emission tomography.Psychopharmacology. 1992; 106: 14-18
- Structural brain abnormalities in bipolar affective disorder. Ventricular enlargement and focal signal hyperintensities.Arch Gen Psychiatry. 1990; 47: 1054-1059
- Kinetic analysis of [11C]McN5652.J Cereb Blood Flow Metab. 1999; 19: 967-981
- A new multiple quantum filter design procedure for use on strongly coupled spin systems found in vivo.Magn Reson Med. 1998; 39: 762-771
- Imaging central nicotinic acetylcholine receptors in baboons with [18F]fluoro-A-85380.J Nucl Med. 1999; 40: 1374-1380
- MRI findings in patients with affective disorder.Acta Psychiatr Scand. 1997; 96: 157-168
- Performance of 2D 1H spectroscopic imaging of the brain.Magn Reson Imaging. 1999; 17: 919-931
- Effects of vigabatrin intake on brain GABA activity as monitored by spectrally edited magnetic resonance spectroscopy and positron emission tomography.Magn Reson Imaging. 1999; 17: 417-425
- Computed tomography in schizophreniform disorder and other acute psychiatric disorders.Arch Gen Psychiatry. 1982; 39: 778-783
- Dopamine receptor binding of C-11-3-N-methylspiperone in the caudate in schizophrenia and bipolar disorder.Psychopharmacol Bull. 1985; 21: 595-598
- Age-related MRI abnormalities in bipolar illness.Biol Psychiatry. 1995; 38: 846-847
- Cerebellar atrophy in schizophrenia and affective disorder.Am J Psychiatry. 1987; 144: 465-467
- Cardiovascular risk factors in affective disorder.J Affect Disord. 1987; 12: 129-134
- Applications of fMRI to research in psychiatry.in: Heiserman J.E. Drayer B.P. Neuroimaging Clinics of North America. Saunders, Philadelphia1999: 295-309
- Deficits in gray matter volume are present in schizophrenia but not bipolar disorder.Schizophr Res. 1997; 26: 85-92
- Gender and age influences on human brain muopioid receptor binding measured by PET.Am J Psychiatry. 1999; 156: 842-848
Article info
Publication history
Accepted:
July 6,
2000
Received in revised form:
July 3,
2000
Received:
February 15,
2000
Identification
Copyright
© 2000 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
