Decreased cerebral blood flow in the limbic and prefrontal cortex using SPECT imaging in a cohort of completed suicides

• Published in: Translational psychiatry Vol. 1; no. 8; p. e28
• Main Authors: Willeumier, K, Taylor, D V, Amen, D G
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09.08.2011; Nature Publishing Group
• Subjects: 631/443/1338/2729; 692/698/1688/64; 692/699/476/1414; 692/700/1421/1846/2771; Adult; Behavioral Sciences; Biological Psychology; Cerebrovascular Circulation - physiology; Comorbidity; Depression - diagnostic imaging; Depression - epidemiology; Depression - physiopathology; Female; Gyrus Cinguli - blood supply; Gyrus Cinguli - diagnostic imaging; Gyrus Cinguli - physiopathology; Humans; Male; Medicine; Medicine & Public Health; Mental Disorders - diagnostic imaging; Mental Disorders - epidemiology; Mental Disorders - physiopathology; Middle Aged; Neurosciences; Original; original-article; Pharmacotherapy; Prefrontal Cortex - blood supply; Prefrontal Cortex - diagnostic imaging; Prefrontal Cortex - physiopathology; Psychiatric Status Rating Scales; Psychiatry; Radiopharmaceuticals; Retrospective Studies; Suicide; Tomography, Emission-Computed, Single-Photon - instrumentation; Tomography, Emission-Computed, Single-Photon - methods; Young Adult; ADHD; limbic cortex; depression; prefrontal cortex; single-photon emission computed tomography; suicide
• ISSN: 2158-3188; 2158-3188
• DOI: 10.1038/tp.2011.28

Suicide has a high comorbidity with impulsivity and depression, and finding imaging biomarkers indicative of patients at high risk for suicidal behavior is invaluable to the clinician. Using single-photon emission computed tomography (SPECT) imaging, we have previously reported regional cerebral blood flow (rCBF) decreases in the medial prefrontal cortex, ventral tegmental area and subgenual cingulate cortex (Brodmann area 25 (BA 25)), a region found to be hypoperfused with treatment-resistant depression. From 2007 to 2010, we have extended our analysis to include nine additional completed suicides. In all, 27 healthy, age- and gender-matched subjects from a previously acquired healthy brain study served as controls to our 21 completed suicides. All 21 suicides had been previously diagnosed with depression according to Diagnostic and Statistical Manual of Mental Disorder-IV criterion. Voxel-by-voxel analyses were performed using statistical parametric mapping to compare the differences in technetium-99m hexamethylpropylene amine oxime brain uptake between the groups. Factor analysis of the data identified the top 10 regions of hypoperfusion in the suicidal group, including the bilateral superior frontal lobes, the right precuneus, the rolandic operculum, postcentral gyrus, left caudate and insular cortex. We also demonstrate more focal decreases in rCBF in the subgenual cingulate cortex (BA 25) in 18 subjects, supporting our previous hypothesis that hypoperfusion of BA 25 may be a risk factor for suicide in depressed patients. This work suggests that SPECT might be useful in predicting risk for suicide completion in subjects with depression or treatment-resistant depression. Further investigation of this work is necessary to better understand the predictive value of this finding.