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Updated: May 9, 2025
Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Reliability of brain localization using task-based fMRI for late-life depression with suicidal risk
Ai-Ling Hsu1, Changwei W Wu2, Chih-Mao Huang3
1National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Functional magnetic resonance imaging (fMRI) reliably targets brain regions for late-life depression (LLD) treatment. The numerical Stroop task is effective for personalizing transcranial magnetic stimulation in LLD patients across suicidality levels.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Late-life depression (LLD) is a heterogeneous disorder associated with brain network abnormalities and high suicide risk.
- Current treatments like transcranial magnetic stimulation (TMS) targeting the prefrontal cortex lack precision due to group-level targeting methods.
- Personalized fMRI-based targeting exists but its reliability in LLD patients, especially with varying suicidality, remains unevaluated.
Purpose of the Study:
- To evaluate the reliability of functional magnetic resonance imaging (fMRI) for personalizing the targeting of the dorsal and ventral lateral prefrontal cortex (DLPFC and VLPFC) in LLD patients.
- To compare the efficacy of two tasks, numerical Stroop and face/shape matching, for reliable fMRI-based localization in LLD.
- To assess localization reliability across LLD subgroups with different degrees of suicidality.
Main Methods:
- Task-based fMRI was conducted on 103 LLD patients, categorized into non-suicidal risk (NS), ideation/plans (IP), and past suicide attempts (SA) subgroups.
- Voxel-wise statistical analyses and localization success rates for DLPFC and VLPFC were determined using numerical Stroop and face/shape matching tasks.
- Localization reliability was assessed by detecting significant brain activity within predefined masks for each task and subgroup.
Main Results:
- The numerical Stroop task demonstrated high reliability, successfully localizing the bilateral DLPFC in all subgroups (98-100%) and the VLPFC in most cases (88-97%).
- The face/shape matching task showed lower reliability, localizing the bilateral DLPFC in two-thirds of patients but failing to detect the VLPFC.
- Localization success rates for DLPFC were 98% (NS), 100% (IP), and 100% (SA); VLPFC rates were 95% (NS), 97% (IP), and 88% (SA).
Conclusions:
- Task-based fMRI, particularly the numerical Stroop task, is a reliable method for the personalized localization of DLPFC and VLPFC in LLD patients.
- This reliable targeting approach holds significant potential for improving the efficacy of TMS and other focal brain stimulation therapies for LLD.
- The findings support the use of fMRI for tailored treatment strategies in LLD, considering individual differences in suicidality.
