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July 1996

Cerebral Structural Abnormalities in Obsessive-compulsive DisorderA Quantitative Morphometric Magnetic Resonance Imaging Study

Author Affiliations

From the Departments of Psychiatry (Drs Jenike, Breiter, Baer, Savage, O'Sullivan, Rauch, and Keuthen and Messrs Olivares and Shera) and Radiology (Drs Breiter, Kennedy, Rauch, and Rosen), Nuclear Magnetic Resonance Center (Drs Breiter, Kennedy, O'Sullivan, and Rosen), and Department of Neurology (Drs Kennedy, Caviness, and Filipek), Massachusetts General Hospital and Harvard Medical School, Boston.

Arch Gen Psychiatry. 1996;53(7):625-632. doi:10.1001/archpsyc.1996.01830070073011

Background:  A previous pilot study of only posterior brain regions found lower white-matter volume in patients with obsessive-compulsive disorder than in normal control subjects. We used new cohorts of patients and matched normal control subjects to study wholebrain volume differences between these groups with magnetic resonance imaging-based morphometry.

Methods:  Ten female patients with obsessivecompulsive disorder and 10 female control subjects, matched for handedness, age, weight, education, and verbal IQ, underwent magnetic resonance imaging with a 3-dimensional volumetric protocol. Scans were blindly normalized and segmented by means of well-characterized semiautomated intensity contour mapping and differential intensity contour algorithms. Brain structures investigated included the cerebral hemispheres, cerebral cortex, diencephalon, caudate, putamen, globus pallidus, hippocampus, amygdala, third and fourth ventricles, corpus callosum, operculum, cerebellum, and brain stem. Anterior to posterior neocortical regions, including precallosum, anterior pericallosum, posterior pericallosum, and retrocallosum, with adjacent white matter were also measured. Volumes found different between groups were correlated with Yale-Brown Obsessive Compulsive Scale score and Rey-Osterieth Complex Figure Test measures.

Results:  Confirming results of our earlier pilot study and expanding the findings to the whole brain, patients with obsessive-compulsive disorder had significantly less total white matter but, in addition, significantly greater total cortex and opercular volumes. Severity of obsessive-compulsive disorder and nonverbal immediate memory correlated with opercular volume.

Conclusions:  Replication of volumetric white-matter differences suggests a widely distributed structural brain abnormality in obsessive-compulsive disorder. Whereas determining the etiogenesis may require research at a microscopic level, understanding its functional significance can be further explored via functional neuroimaging and neuropsychological studies.