Personalized target selection for TMS therapy using functional vs. structural connectivity MRI

使用功能性与结构性连接 MRI 进行 TMS 治疗的个性化靶点选择

• 批准号: 9433834
• 负责人: Joan A Camprodon
• 金额: $ 25.17万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-11 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9433834
• 关键词: Address; Affect; Anatomy; Anisotropy; Anterior; Antidepressive Agents; Clinical; Clinical Data; Corpus Callosum; Corticospinal Tracts; Data; Data Analyses; Data Set; Databases; Diffusion; Diffusion Magnetic Resonance Imaging; Disease remission; Electromagnetics; FDA approved; Fiber; Forcep; Functional Magnetic Resonance Imaging; Future; Goals; Grant; Human; Intervention; Investigational Therapies; Left; Life; Location; Magnetic Resonance Imaging; Major Depressive Disorder; Measures; Mental Depression; Methodology; Methods; Modality; Patients; Physiologic pulse; Precision therapeutics; Prefrontal Cortex; Property; Refractory; Reproducibility; Rest; Safety; Scanning; Thalamic structure; Therapeutic; Therapeutic Trials; Time; Tissues; Transcranial magnetic stimulation; Treatment Efficacy; Ventral Striatum; base; brain tissue; clinical efficacy; cohort; comparative; connectome; human subject; image guided; imaging modality; improved; individual patient; multimodality; neuropsychiatry; novel strategies; open label; personalized approach; precision medicine; prospective; response; temporal measurement; therapeutic target; tractography; treatment response; white matter

Project Summary Title: Personalized target selection for TMS therapy using functional vs. structural connectivity MRI Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for major depressive disorder (MDD). Remission rates are estimated to be around 30%, similar to other antidepressant therapies yet still suboptimal. A key reason for the variability in response is the lack of an individualized approach that identifies the cortical therapeutic target for each patient. A proposed strategy is to use functional connectivity MRI to identify the topography of functional networks relevant to MDD. In this project, we propose a novel strategy to personalized identification of TMS targets by using diffusion MRI (dMRI) to identify the white matter bundles that connect two critical nodes affected by MDD: the left prefrontal cortex (PFC) and the subgenual cingulate (SGC). We will study 500 subjects from the Human Connectome Project (HCP) and 20 patients with MDD who were treated with TMS. We will use state-of-the-art functional connectivity and diffusion MRI data and analyses. Our goal is to quantify and compare, for the first time, the reliability of these methods to identify cortical targets for TMS therapy. In addition we will study the clinical efficacy of dMRI-guided TMS by retrospectively analyzing the relationship between therapeutic response and location of the stimulated TMS target in relation to the optimal dMRI node. Last, we will use sophisticated dMRI metrics to assess the changes in white matter microstructure induced by TMS and how they relate to clinical efficacy (therefore defining anatomical mechanisms of action and therapeutic targets). Results from this project will support future prospective trials aiming to confirm target engagement and therapeutic response using individualized dMRI-guided TMS in MDD and other neuropsychiatric conditions.

项目摘要 标题：使用功能与结构连接性MRI进行TMS治疗的个性化目标选择 经颅磁刺激（TMS）是对主要抑郁症（MDD）的FDA批准治疗方法。 缓解速率估计约为30％，类似于其他抗抑郁药疗法，但仍处于次优。 响应可变性的关键原因是缺乏识别皮质的个性化方法 每个患者的治疗靶标。提出的策略是使用功能连接MRI来识别 功能网络的地形与MDD相关。在这个项目中，我们提出了一种新颖的策略来个性化 通过使用扩散MRI（DMRI）来识别TMS目标的识别，以识别连接的白质束 受MDD影响的两个关键节点：左前额叶皮层（PFC）和亚果扣扣（SGC）。我们将 研究500名来自人类Connectome项目（HCP）的受试者和20例接受治疗的MDD患者 与TMS。我们将使用最新的功能连接性和扩散MRI数据和分析。我们的目标是 首次量化和比较这些方法的可靠性以识别TMS的皮质靶标 治疗。此外，我们将通过回顾性分析DMRI引导TMS的临床功效 治疗反应与受刺激的TMS目标的位置之间的关系相对于最佳 DMRI节点。最后，我们将使用复杂的DMRI指标来评估白奇微观结构的变化 由TMS诱导及其与临床疗效的关系（因此定义了作用的解剖机制 和治疗靶标）。该项目的结果将支持未来的前瞻性试验，以确认目标 使用个性化DMRI引导的TMS和其他中的DMRI引导的TMS参与和治疗反应 神经精神疾病。