Background Major depressive disorder (MDD) has different clinical presentations in males and females. However, the neuroanatomical mechanisms underlying these sex differences are not fully understood. Objective The purpose of present study was to explore the sex differences in brain cortical thickness (CT) and surface area (SA) of MDD and the relationship between these differences and clinical manifestations in different gender. Methods High-resolution T1-weighted images were acquired from 61 patients with MDD and 61 healthy controls (36 females and 25 males, both). The sex differences in CT and SA were obtained using the FreeSurfer software and compared between every two groups by post hoc test. Spearman correlation analysis was also performed to explore the relationships between these regions and clinical characteristics. Results In male patients with MDD, the CT of the right precentral was thinner compared to female patients, although this did not survive Bonferroni correction. The SA of several regions, including right superior frontal, medial orbitofrontal gyrus, inferior frontal gyrus triangle, superior temporal, middle temporal, lateral occipital gyrus, and inferior parietal lobule in female patients with MDD was smaller than that in male patients (P < 0.01 after Bonferroni correction). In female patients, the SA of the right superior temporal (r = 0.438, P = 0.008), middle temporal (r = 0.340, P = 0.043), and lateral occipital gyrus (r = 0.372, P = 0.025) were positively correlated with illness duration. Conclusion The current study provides evidence of sex differences in CT and SA in patients with MDD, which may improve our understanding of the sex-specific neuroanatomical changes in the development of MDD.

目的:基于3D-T1 WI高分辨MRI,探讨重度抑郁症(MDD)患者脑灰质体积的性别差异及有性别差异脑区的灰质体积与临床指标的相关性.方法:将25例男性、36例女性M DD患者及25例男性、36例女性健康志愿者纳入本研究,所有被试行3D-T1 WI高分辨M RI扫描.建立双因素方差分析模型,获得4组间灰质体积有性别差异的脑区,将男、女性M DD患者之间有性别差异脑区的灰质体积与临床指标[17项汉密尔顿抑郁量表(HAMD)评分、病程及发病年龄]进行相关性分析.结果:四组之间双因素方差分析主效应结果显示男性灰质体积小于女性的脑区包括左侧额中回、左侧中央后回、右侧额叶内侧回、右侧舌回、双侧额上回、双侧中央前回、双侧颞中回和双侧丘脑.Post-hoc法组间两两比较结果显示,与女性M DD组比较,男性M DD组的左侧额中回、左侧中央前回、右侧额叶内侧回、双侧额上回、双侧中央前回及双侧丘脑的灰质体积减小(P<0.05,Alphasim校正).相关性分析结果显示仅男性MDD患者的左侧颞中回和左侧额中回的灰质体积与HAMD评分呈负相关(r=-0.418,P=0.042;r=-0.498,P=0.013);女性M DD患者的有差异脑区的灰质体积与临床指标间均无显著相关性(P>0.05).结论:MDD患者存在性别特异性灰质体积改变,这些改变可能与临床症状有关.

Some important clinical characteristics of major depressive disorder (MDD) differ between sexes. We explored abnormal spontaneous neuronal activity in MDD patients using the amplitude of low-frequency fluctuation (ALFF) and its relationship to clinical manifestations in male and female patients, to seek the neural mechanisms underlying sex-related differences in depression. Twenty-five male MDD patients, 36 female MDD patients, and 25 male and 36 female matched healthy controls (HC) were included. The ALFF difference was investigated among four groups, and partial correlation analysis was used to explore a possible clinical relevance. The main effect results of sex difference were located in the bilateral caudate nucleus and posterior cingulate gyrus. Post hoc comparisons found that the male MDD patients showed decreased ALFF in the bilateral caudate nucleus and posterior cingulate gyrus when compared with female MDD patients/female HCs, and female MDD patients showed increased ALFF in the bilateral caudate nucleus and posterior cingulate gyrus when compared with male HCs. The average ALFF of the right caudate nucleus was positively correlated with illness duration in female MDD patients. Our results suggest that the sex-specific abnormal brain activity might be a potential pathomechanism of different symptoms in male and female MDD patients.

Despite evidence for microstructural brain alterations in epilepsy patients, little is known about how these develop with age and the progress of the disease. The aim of this study was to investigate microstructural abnormalities of the white matter (WM) in children with new-onset, untreated idiopathic-generalized epilepsy (IGE) using the MRI technique of diffusion tensor imaging (DTI). The study was approved by the institutional review board, and all individuals or their parents gave signed informed consent. In total, 45 patients with IGE (age 5-18 years, male: female 26:19) and 32 healthy controls (HCs; age 5-18 years, male: female 21:11) were included. Voxel-based analysis (VBA) was used to compare patients and controls, and Pearson correlation analysis was used to investigate relationships between altered DTI metrics and clinical parameters. Compared with controls, patients with IGE showed increased mean diffusivity (MD) in the left splenium of the corpus callosum, increased fractional anisotropy (FA) in the right WM of the superior and middle frontal gyri, increased axial diffusivity (AD) in the WM of right corona radiata and left occipital lobe, and decreased AD in the WM of the left thalamus and the right middle cerebellar peduncle. There was no correlation between the altered diffusion parameters and clinical measures. Our study demonstrated several distinct microstructural impairments in children with new-onset, untreated IGE, of which altered AD might be the most sensitive marker of dysmyelination. The increased FA in the IGE group might suggest an initiating or compensatory mechanism that is activated prior to cognitive decline in these children.

目的 探讨重性抑郁症(major depressive disorder,MDD)患者灰白质表面面积改变的性别差异,并分析其与不同性别患者临床特征间的关系.材料与方法 前瞻性收集61例MDD患者和匹配的61例健康对照(两组均为男性25例、女性36例)行3D T1WI高分辨率磁共振扫描,用freeSurfer软件进行图像预处理,获得全脑各区域的灰、白质表面面积图像,采用双因素方差分析计算并提取四组间灰、白质表面面积的性别差异脑区,行post-hoc检验进行各组间两两比较,将男女性MDD性别差异脑区与临床资料进行相关分析.结果 性别差异主结果显示双侧额上回、颞中回及左侧额中回喙部、枕外侧回灰、白质表面面积均存在差异,且双侧颞上回、左侧中央前回、岛叶、右侧额叶三角部、眶额内侧回、梭状回、顶下小叶白质表面面积及左侧缘上回、右侧额中回喙部、中央前回、颞下回、梭状回、前缘扣带回、枕外侧回、顶下小叶灰质表面面积存在差异(P<0.01,Bonforroni校正).进一步post-hoc两两比较发现以上脑区女性MDD组灰、白质表面面积均小于男性MDD组(P<0.01,Bonforroni校正).相关分析显示男性MDD组右侧额中回喙部(r=-0.398,P=0.049)及梭状回(r=-0.440,P=0.028)灰质表面面积与汉密尔顿抑郁量表评分呈负相关,左侧颞中回灰质表面面积与男性MDD病程呈负相关(r=-0.419,P=0.037).结论 MDD患者灰、白质表面面积均存在性别差异,但是差异脑区并不完全重叠,这些差异脑区可能与男女性MDD患者临床表现和发病率的差异有关.

患者男,48岁,因“右面部肿胀伴疼痛半月”入院.查体:右侧面部下颌升支区域弥漫肿胀,有触痛.实验室检查:淋巴细胞百分比17.7％,红细胞计数6.04×109/L,平均红细胞体积68.4 fL,平均红细胞血红蛋白量21.6 pg,平均血小板体积13.9 fL;肿瘤标记物未见异常.CT平扫:右侧下颌支远段-下颌头溶骨性骨质破坏,周围可见软组织肿块,与邻近咬肌、翼外肌分界不清(图1A);考虑肿瘤性病变.MRI:右侧下颌头区骨质破坏伴周围软组织肿块,大小约1.6 cm×2.3 cm×3.1 cm,呈长T2、等T1信号(图1B),STIR呈高信号,边界清晰,增强后肿块呈轻度较均匀强化(图1C);考虑肿瘤性病变.行右侧下颌骨区包块切除术,术后病理示组织细胞增生性病变(图2);病理诊断:(下颌骨)朗格汉斯细胞组织细胞增生症(Langerhans cellhistiocytosis,LCH).

Dynamic functional connectivity (dFC) is a newly developed analysis strategies which could provide novel understandings of the pathophysiological mechanisms of neuropsychiatric disease. 45 adolescents diagnosed with IGE and 32 well-matched healthy controls completed this study using dynamic functional connectivity (dFC). The decreased dFC between two seed regions(MCC and ParaHipp) and PCC and IPL were part of default mode network(DMN). The impaired DMN in adolescent IGE patients suggest dFC might be more sensitive to reflect the changes of brain function in the early stage of disease and dFC analysis was a promising avenue to deepen our understanding of this disease.