MR perfusion-weighted imaging and quantitative analysis of cerebral hemodynamics with symptom provocation in unmedicated patients with obsessive-compulsive disorder

We evaluated the potential effectiveness of dynamic contrast-enhanced perfusion-weighted images (PWI) in determining hemodynamic activation in brain structures that may be involved in mediating the symptomatology of patients with obsessive-compulsive disorder (OCD), as manifested by contamination obsessions with washing compulsions. Ten unmedicated female patients with OCD were subjected to PWI, and relative cerebral blood flow (rCBF) in each region of interest (ROI) and self-ratings of OCD symptoms were compared before and after symptom provocation. We found that increases in the Anxiety Analogue Scale (AAS) and OCD Analogue Scale (OCDAS) scores were each significantly associated with provocation. The correlations between OCDAS and AAS scores were also statistically significant during both the control and provoked conditions. Compared with the control state, there was a significant increase in rCBF during the symptomatic state in the right head of caudate nucleus, thalamus, and bilateral orbitofrontal cortices (OFC). No statistical changes in rCBF were found in the bilateral anterior cingulate cortices (ACC). These findings demonstrate that OCD symptomatology is accompanied by anxiety, and that abnormal features are particularly apparent in the orbitofrontal-subcortical circuits. (C) 2004 Elsevier Ireland Ltd. All rights reserved.