Structural and Functional Changes Of Post-Stroke Depression：A Multimodal Magnetic Resonance Imaging Study

Abstract

Post-stroke depression (PSD) is a prevalent condition that hinders recovery and quality of life after a stroke. This study investigated changes in gray matter volume (GMV), white matter microstructure, and spontaneous brain activity in PSD with a single subcortical infarct 1 month after stroke using multiple MRI techniques, including neurite orientation dispersion and density imaging (NODDI). We assessed changes in GMV, neurite density index (NDI), orientation dispersion index (ODI), fraction of isotropic water (ISO), fractional anisotropy (FA), and the amplitude of frequency fluctuations (ALFF) between PSD (n = 20), post-stroke without depression (n = 20), and normal control (n = 20) groups. Receiver operating characteristic (ROC) curve analysis was performed to test the diagnostic performance of the different MRI modality parameters that showed the strongest correlation with depressive symptoms. Compared to post-stroke patients without depression (non-PSD), those with PSD showed increased ODI and ISO in the widespread white matter, as well as increased ALFF in the left pallidum. No significant differences in the GMV or FA were observed between the two groups. Furthermore, the ODI of the right superior longitudinal fasciculus showed superior diagnostic performance for PSD (the areas under the ROC curves (AUC) = 0.917). The model of parameters derived from NODDI combined with other MRI modality parameters (i.e., GMV and ALFF) showed better diagnostic performance than that of FA derived from diffusion tensor imaging (DTI). These findings suggest that PSD with a single subcortical infarct 1 month after stroke is associated with structural and functional abnormalities that may contribute to depressive symptoms. Additionally, NODDI is more sensitive for quantifying white matter microstructural damage in PSD.

Note:
Funding declaration: This study was supported by grants from the National Natural Science Foundation of China (82260243), Guangxi Natural Science Foundation (2022GXNSFBA035501), and the Self-financing Scientific Research Project of Guangxi Health Commission (Z20210864).

Conflict of Interests: None.

Ethical Approval: Approval was granted by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (No.2024-E586-01). Informed consent was obtained from all individual participants included in the study.

Keywords: gray matter volume, neurite orientation dispersion and density imaging, amplitude of frequency fluctuations, multimodal MRI, post-stroke depression