Premenstrual dysphoric disorder (PMDD) is a mood disorder for which selective progesterone receptor modulator (SPRM) treatment has been demonstrated to be beneficial. The neural signatures of this treatment have been so far identified as greater fronto-cingulate reactivity during aggressive response to provocation, but no changes in terms of gray matter structure. White matter has recently been found to differ between patients with PMDD and healthy controls. The present study thus sought to investigate the relationship between white matter volume and SPRM treatment in patients with PMDD. A pharmaco-neuroimaging study was conducted on patients with PMDD participating in a randomized controlled trial. Participants underwent magnetic resonance imaging before and after treatment randomization to ulipristal acetate (an SPRM), or placebo, for three months. The interaction effect of treatment by time on white matter volume (WMV) was assessed. Voxel based morphometry analyses were performed on both a whole brain exploratory level and on regions of interest. No treatment effect was observed on WMV in any region, including the anterior thalamic radiations, cingulum, forceps minor, fornix, inferior fronto-occipital fasciculus, superior cerebellar peduncle, superior longitudinal fasciculus, and uncinate fasciculus. This is the first finding to indicate that no white matter volume alterations follow three-month progesterone antagonism, suggesting that white matter volume does not participate in symptom relief upon SPRM treatment for PMDD.

中文翻译：

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经前焦虑症患者的白质体积和选择性孕酮受体调节剂治疗

经前焦虑症 (PMDD) 是一种情绪障碍，选择性黄体酮受体调节剂 (SPRM) 治疗已被证明是有益的。迄今为止，这种治疗的神经特征已被确定为在对挑衅做出攻击性反应期间额扣带皮层反应性更强，但灰质结构没有变化。最近发现经前抑郁症患者和健康对照者的白质存在差异。因此，本研究旨在探讨 PMDD 患者白质体积与 SPRM 治疗之间的关系。对参与随机对照试验的经前抑郁症患者进行了一项药物神经影像研究。参与者在随机接受醋酸乌利司他（SPRM）或安慰剂治疗三个月之前和之后接受了磁共振成像。评估了治疗时间对白质体积（WMV）的交互作用。在全脑探索水平和感兴趣区域上进行基于体素的形态测量分析。任何区域的WMV均未观察到治疗效果，包括丘脑前部、扣带回、小镊子、穹窿、额枕下束、小脑上脚、上纵束和钩束。这是第一个发现，三个月黄体酮拮抗剂后白质体积没有变化，表明白质体积不参与 SPRM 治疗 PMDD 的症状缓解。