The Role of Brain Connectome Imaging in the Estimation of Depressive Relapse Risk

Abstract

Background About two-thirds of all patients with major depressive disorder (MDD) suffer from depressive relapse, the mechanisms of which are still poorly understood. In recent years, analyses of the brain’s connectome have increasingly been employed to identify potential biomarkers of depressive relapse. The term “connectome” refers to the map of all structural or functional connections in the brain. It can be investigated by structural or functional magnetic resonance imaging followed by graph theory-based analysis to characterize network topology on the global and regional level.

Methods This review is based on a selective literature search in PubMed representing the current state of research, as well as on an already published study which was awarded the Promotionspreis of the Deutsche Röntgengesellschaft.

Results and Conclusion Numerous studies point to altered network topology, e. g., of default-mode network and striatum, as being crucial for the pathophysiology of MDD. Our group was able to show that striatal centrality (or hubness) is associated with the number of depressive episodes, which is one of the best predictors for depressive relapse. These data suggest aberrant striatal network topology as a potential biomarker for depressive relapse risk. The translation of these promising findings into clinical routine diagnostics is promoted by several methodological advantages, while some unresolved issues still hinder this process.

Key points 

• About two-thirds of all patients with MDD suffer from depressive relapse.

• The mechanisms of depressive relapse are still poorly understood.

• Imaging the brain’s connectome can contribute to better understanding of depressive relapse.

• The term “connectome” comprises all structural and functional connections of the brain.

• Altered striatal network topology could be associated with depressive relapse risk.

Citation Format

• Brandl F, Meng C, Zimmer C et al. The Role of Brain Connectome Imaging in the Estimation of Depressive Relapse Risk. Fortschr Röntgenstr 2018; 190: 1036 – 1043

Zusammenfassung

Hintergrund Ungefähr zwei Drittel aller Patienten mit depressiver Störung (major depressive disorder, MDD) erleiden ein Rezidiv. Die Mechanismen des depressiven Rezidivs sind allerdings noch wenig verstanden. In den letzten Jahren wurde zunehmend das Konnektom des Gehirns untersucht, um mögliche Biomarker eines depressiven Rezidivs zu identifizieren. Der Begriff „Konnektom“ beschreibt die Karte aller struktureller und funktioneller Verbindungen des Gehirns. Es kann mittels struktureller oder funktioneller Magnetresonanztomografie und anschließender Graphentheorie-basierter Analyse untersucht werden, um die Netzwerk-Topologie auf globaler und regionaler Ebene zu beschreiben.

Methode Diese Übersichtsarbeit basiert auf einer selektiven Literaturrecherche in PubMed, die den aktuellen Forschungsstand repräsentiert, sowie auf einer eigenen bereits publizierten Arbeit, die mit dem Promotionspreis der Deutschen Röntgengesellschaft ausgezeichnet wurde.

Ergebnisse und Schlussfolgerungen Zahlreiche Studien zeigen, dass eine veränderte Netzwerk-Topologie, z. B. von Default-mode Netzwerk und Striatum, eine entscheidende Rolle in der Pathophysiologie der Depression spielt. Unsere Arbeitsgruppe konnte zeigen, dass striatale Netzwerk-Zentralität (oder Hubness) mit der Anzahl depressiver Episoden assoziiert ist, welche einer der besten Prädiktoren für ein depressives Rezidiv ist. Diese Daten legen aberrante striatale Netzwerk-Topologie als möglichen Biomarker eines depressiven Rezidivs nahe. Die Translation dieser vielversprechenden Befunde in die klinische Routine-Diagnostik wird durch zahlreiche methodologische Vorteile befördert, wohingegen einige ungelöste Probleme diesen Prozess noch behindern.

Kernaussagen 

• Ungefähr zwei Drittel aller Patienten mit Depression erleiden ein Rezidiv.

• Die Mechanismen des depressiven Rezidivs sind noch wenig verstanden.

• Die Bildgebung des Gehirn-Konnektoms kann zum besseren Verständnis des depressiven Rezidivs beitragen.

• Der Begriff „Konnektom“ umfasst alle strukturellen und funktionellen Verbindungen/Netzwerke des Gehirns.

• Eine veränderte striatale Netzwerk-Topologie könnte mit dem depressiven Rezidivrisiko assoziiert sein.

Key words

brain - MR-functional imaging - functional connectivity - graph theory - major depressive disorder

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