BACKGROUND Electroconvulsive therapy (ECT) is the most effective treatment option for major depressive disorder, so understanding whether its clinical effect relates to structural brain changes is vital for current and future antidepressant research. OBJECTIVE To determine whether clinical response to ECT is related to structural volumetric changes in the brain as measured by structural magnetic resonance imaging (MRI) and, if so, which regions are related to this clinical effect. We also determine whether a similar model can be used to identify regions associated with electrode placement (unilateral versus bilateral ECT). METHODS Longitudinal MRI and clinical data (Hamilton Depression Rating Scale) was collected from 10 sites as part of the Global ECT-MRI research collaboration (GEMRIC). From 192 subjects, relative changes in 80 (sub)cortical areas were used as potential features for classifying treatment response. We used recursive feature elimination to extract relevant features, which were subsequently used to train a linear classifier. As a validation, the same was done for electrode placement. We report accuracy as well as the structural coefficients of regions included in the discriminative spatial patterns obtained. RESULTS A pattern of structural changes in cortical midline, striatal and lateral prefrontal areas discriminates responders from non-responders (75% accuracy, p < 0.001) while left-sided mediotemporal changes discriminate unilateral from bilateral electrode placement (81% accuracy, p < 0.001). CONCLUSIONS The identification of a multivariate discriminative pattern shows that structural change is relevant for clinical response to ECT, but this pattern does not include mediotemporal regions that have been the focus of electroconvulsive therapy research so far.

中文翻译：

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电休克疗法引起的结构变化与临床结果相关

背景电休克疗法（ECT）是重度抑郁症最有效的治疗选择，因此了解其临床效果是否与大脑结构变化有关对于当前和未来的抗抑郁药研究至关重要。目的 确定对 ECT 的临床反应是否与结构磁共振成像 (MRI) 测量的大脑结构体积变化有关，如果是，则哪些区域与这种临床效果有关。我们还确定是否可以使用类似的模型来识别与电极放置相关的区域（单侧与双侧 ECT）。方法 作为全球 ECT-MRI 研究合作 (GEMRIC) 的一部分，从 10 个地点收集纵向 MRI 和临床数据（汉密尔顿抑郁评定量表）。从192个科目中，80 个（亚）皮质区域的相对变化被用作对治疗反应进行分类的潜在特征。我们使用递归特征消除来提取相关特征，随后用于训练线性分类器。作为验证，对电极放置也进行了同样的操作。我们报告了获得的区分空间模式中包含的区域的准确性和结构系数。结果 皮质中线、纹状体和外侧前额叶区域的结构变化模式区分有反应者和无反应者（75% 准确度，p < 0.001），而左侧中颞变化区分单侧和双侧电极放置（81% 准确度，p < 0.001 ）。