Transcranial magnetic stimulation (TMS) is an approved intervention for treatment-resistant depression (TRD), but current targeting approaches are only partially successful. Our objectives were (1) to examine the feasibility of MRI-guided TMS in the clinical setting using a recently published surface-based, multimodal parcellation in patients with TRD who failed standard TMS (sdTMS); (2) to examine the neurobiological mechanisms and clinical outcomes underlying MRI-guided TMS compared to that of sdTMS. We used parcel-guided TMS (pgTMS) to target the left dorsolateral prefrontal cortex parcel 46. Resting-state functional connectivity (rsfc) was assessed between parcel 46 and predefined nodes within the default mode and visual networks, following both pgTMS and sdTMS. All patients (n = 10) who had previously failed sdTMS responded to pgTMS. Alterations in rsfc between frontal, default mode, and visual networks differed significantly over time between groups. Improvements in symptoms correlated with alterations in rsfc within each treatment group. The outcome of our study supports the feasibility of pgTMS within the clinical setting. Future prospective, double-blind studies of pgTMS vs. sdTMS appear warranted.

经颅磁刺激 (TMS) 是经批准的治疗难治性抑郁症 (TRD) 的干预措施，但目前的靶向方法仅部分成功。我们的目标是 (1) 使用最近发表的基于表面的多模式分割方法，在标准 TMS (sdTMS) 失败的 TRD 患者中检查 MRI 引导的 TMS 在临床环境中的可行性；(2) 与 sdTMS 相比，检查 MRI 引导的 TMS 的神经生物学机制和临床结果。我们使用包裹引导 TMS (pgTMS) 来瞄准左侧背外侧前额叶皮层包裹 46。在 pgTMS 和 sdTMS 之后，在默认模式和视觉网络中评估包裹 46 和预定义节点之间的静息状态功能连接 (rsfc)。所有患者（n = 10) 之前未能通过 sdTMS 的人对 pgTMS 有反应。额叶、默认模式和视觉网络之间的 rsfc 变化随时间的推移在组之间显着不同。症状的改善与每个治疗组内 rsfc 的变化相关。我们的研究结果支持 pgTMS 在临床环境中的可行性。pgTMS 与 sdTMS 的未来前瞻性、双盲研究似乎是有必要的。