The Use of Magnetic Resonance Imaging (MRI) in Eating Disorders

Study
Participants
Age (years)
BMI (kg/m2)
Duration of illness/recovery
Medication
Additional relevant information (e.g., specific exclusion criteria, report on ED severity measure)
Boghi et al. (2011)
AN-R: n = 21
AN-R: 29 ± 10.1
AN-R: 15.5 ± 1.8
Illness (in years):
All patients on SSRI treatment
Exclusion criterion: past or current alcohol or substance abuse
“Short” duration: n = 10
HC: 30.8 ± 8.7
HC: 21.9 ± 1.5
AN-R: 11.3 ± 12.1
No measure of ED severity reported
“Long” duration: n = 11
“Short”: 1.9 ± 1.3
HC: n = 27 (Age-matched)
“Long”: 19.8 ± 11.1
Brooks et al. (2011a)
AN: n = 14
AN: 26 ± 7.1
AN: 15.6 ± 1.5
Illness (in years):
NR
ED severity measure: Eating Disorder Examination Questionnaire
“AN-R: n = 8”
“AN-R: 26 ± 10.9”
“AN-R: 15.1 ± 1.9”
AN: 9.2 ± 7.1
“AN-BP: n = 6”
“AN-BP: 27 ± 9.7”
“AN-BP: 16.2 ± 1.1”
“AN-R: 9.2 ± 11.6”
HC: n = 21 (Age-matched)
HC: 26 ± 9.6
HC: 21.4 ± 2.3
“AN-BP: 9.2 ± 8.2”
Castro Fornieles et al. (2009)
AN: n = 12
AN: 14.5 ± 1.5
AN (baseline): 14.8 ± 2.0
NR
1 at baseline and 3 at follow-up on fluoxetine or fluvoxamine
One male in each group
(9 AN-R; 3 AN-BP)
HC: 14.6 ± 3.2
AN (follow-up): 18.8 ± 0.4
ED severity measure: Eating Attitudes Test
HC: n = 9
HC: not reported
Gaudio et al. (2011)
AN-R: n = 16
AN-R: 15.2 ± 1.7
AN-R: 14.2 ± 1.4
Illness (in months):
All on clomipramine or SSRI (duration of treatment: 16.4 ± 6.4 days)
Exclusion criterion: current or past other DSM-IV-TR disorders
HC: n = 16
HC: 15.1 ± 1.5
HC: 20.2 ± 1.6
AN-R 5.3 ± 3.2
10 on haloperidol (0.5–2.0 mg/day; mean dose: 1.3 ± 0.5 mg/day; mean duration of treatment: 9.2 ± 6.4 days)
ED severity measure: Eating Attitudes Test
Joos et al. (2010)
AN-R: n = 12
AN-R: 25.0 ± 4.8
AN-R: 16.0 ± 1.2
Illness (in years):
AN-R:1 on sertraline 75 mg/day
AN-R group: 1 participant had “inconstant bulimic phases” and 1 used laxatives
BN: n = 17
BN: 24.5 ± 4.8
BN: 21.1 ± 2.5
AN-R: 4.7 ± 3.6 years
ED severity measure: Eating Disorder Inventory
HC: n = 18 (Age-matched)
HC: 26.9 ± 5.7
HC: 21.2 ± 2.0
BN: 7.5 ± 5.7 years
Muhlau et al. (2007)
rAN-R: n = 22
rAN-R: median 22.3 (range: 18.4–40.8)
rAN-R: median 19.5 (range: 17.0–22.8)
Recovery (in months):
NR
Exclusion criteria: lifetime history of post-traumatic stress disorder, manic episodes, schizophrenia, obsessive compulsive disorder, substance use disorders, or borderline personality disorder. Major depressive disorder occurring outside episodes of low weight was also an exclusion criterion. During episodes of low weight at least 16 rAN-R, participants had met the criteria for depressive disorder at least once
HC: n = 37
HC: median 23.8 (range: 18.3–40.2)
HC: 20.1 median 22.3 (range: 18.3–24.8)
rAN-R: median 15.5 (range: 6–60)
Lifetime lowest BMI: median 13.5 (range: 10.0–16.1)
Duration of AN (years): median 5 (range: 1–23)
Roberto et al. (2011)
AN: n = 32
AN: 26.9 ± 6.4
AN (baseline): 16.0 ± 1.6
Illness (in years):
No medication
Exclusion criteria: “axis I disorder other than major depression” and “history of suicide attempt or other self-injurious behavior within the previous 6 months”
(14 AN-R; 18 AN-BP)
HC: 25.0 ± 3.2
AN (follow-up): 20.0 ± 0.6
AN: 10.2 ± 6.2
Amenorrhea was not considered as a criterion for AN
HC: n = 21
HC (baseline): 20.8 ± 1.2
HC (follow-up): 20.6 ± 1.2
Schafer et al. (2010)
BN-P: n = 14
BN: 23.1 ± 3.8
BN: 22.1 ± 2.5
Illness (in years):
No medication
Exclusion criterion: “clinically relevant depression”
BED: n = 17
BED: 26.4 ± 6.4
BED: 32.2 ± 4.0
BN: 7.3 ± 3.6
ED severity measure: Eating Disorder Inventory
HC: n = 19
HC: 22.3 ± 2.6
HC: 21.7 ± 1.4
BED: 6.8 ± 4.0
Suchan et al. (2010)
AN: n = 15
AN: 26.8 ± 8.4
AN: 16.0 ± 1.3
Illness (in years):
NR
No measure of ED severity reported
HC: n = 15
HC: 29.5 ± 8.2
HC: 22.0 ± 2.1
AN: 5.5 ± 5
Wagner et al. (2006)
rAN-R: n = 14
rANR: 23.7 ± 5.3
rANR: 21.2 ± 2.0
Recovery (in months):
No medication
Comorbid axis I and II assessed but not included in report
rAN-BP: n = 16
rANBP: 27.4 ± 7.2
rANBP: 21.2 ± 1.5
rAN-R: 28.7 ± 20.4
Lifetime lowest BMI:
rBN: n = 10
rBN: 24.0 ± 6.1
rBN: 23.1 ± 2.4
rAN-BP: 39.5 ± 52.7
rANR: 14.1 ± 1.4
HC: n = 31
HC: 26.8 ± 7.3
HC: 21.9 ± 2.0
rBN: 29.8 ± 18.1
rANBP: 14.8 ± 2.0
rBN: 19.2 ± 2.1
HC: 20.1 ± 1.4
Age and body mass index (BMI) are reported as mean ± standard deviation
AN anorexia nervosa, BN bulimia nervosa, BED binge eating disorder, HC healthy control, ED eating disorder, r recovered, RH right-handed, LH left-handed, NR not reported, BMI body mass index, SSRI selective serotonin reuptake inhibitor

18.3 Functional Studies

In this section, we review functional MRI studies according to the different aspects of the eating disorders psychopathology investigated. Eating disorders involve changes in eating behavior and usually, but not always, are associated with overvalued ideas about shape and weight. Additional features include abnormalities in cognitive style, emotional regulation, social functioning, reward sensitivity, and interoceptive awareness (Treasure et al. 2011).

18.3.1 Eating

Abnormal eating behaviors lie at the heart of all forms of EDs. This includes both over and under control of eating, sometimes associated with the interruption of the process of digestion by spitting/vomiting. Table 18.2 summarizes neuroimaging findings on functional activations to food stimuli in people with EDs.
Table 18.2
Summary of neuroimaging findings on functional activations to food stimuli in people with eating disorders
Study
Task
Sample
Main findings
Interpretation
Bohon and Stice (2011)
Gustatory paradigm (palatable vs. neutral food)
BN vs. subthreshold BN vs. HCs
BN < HCs: right prefrontal gyrus (anticipatory and consummatory), left middle frontal gyrus, left thalamus, right posterior insula (consummatory)
People with bulimic symptoms may experience less activation in gustatory and reward regions during anticipation and receipt of palatable foods
Brooks et al. (2011b)
Food vs. nonfood pictures
AN vs. BN vs. HCs
HC > AN, BN: right insular cortex, right superior temporal gyrus, left side cerebellum, left caudate body
AN and BN: activation of cognitive control
AN > BN, HC: left visual cortex, cerebellum, right DLPFC, right precuneus
AN and BN: sustained visual attention to food stimuli (possible substrate for attentional bias)
BN > AN, HC: right visual cortex, right insula, left prefrontal gyrus
BN: greater reward sensitivity
BN < HC: bilateral superior temporal gyrus, insular cortex, left visual cortex
BN < AN: right parietal lobe, left dorsal posterior cingulate
BN > AN: right caudate, right superior temporal gyrus, left supplementary motor area
Burger and Stice (2011)
Gustatory paradigm (palatable food) and food pictures
HCs: high vs. low dietary restraint
High dietary restraint > low dietary restraint (food receipt): OFC, DLPFC
Individuals who report high dietary restraint have a hyperresponsivity in reward-related brain regions when food intake is occurring
Frank et al. (2011)
Reward learning paradigm (association learning between conditioned visual and unconditioned taste stimuli)
BN vs. HCs
BN < HCs: insula, ventral putamen, amygdala, OFC
Altered temporal learning in BN, which could be due to episodic excessive food stimulation which results in desensitization of dopamine circuits
Gizewski et al. (2010)
Food vs. nonfood pictures
AN-R vs. HCs
AN = HCs (hunger): insula (anterior insula in AN; posterior insula in BN)
Food stimuli more emotionally arousing to AN, but more physically stimulating to HCs
Joos et al. (2011a, b)
Food vs. nonfood pictures
AN-R vs. HCs
AN R > HCs: right amygdala
AN: negative feedback loop of emotional processing (dysfunction of the top-down processes of the dorsal stream)
AN R < HCs: cingulate cortex
Pietrini et al. (2011)
Review
AN-R vs. AN-b/p
AN-R: rest < symptom provocation: frontal cortex; cingulate cortex
Possible disturbance of a network involving frontal, parietal, and cingulate metabolism at rest in AN that normalize after recovery
AN-B/P: rest < symptom provocation: frontal, parietal, and cingulate
Santel et al. (2006)
Food vs. nonfood pictures
AN vs. HCs
AN < HCs (satiety): left inferior parietal cortex
Decreased food-related somatosensory processing in AN during satiety. Attentional mechanisms during hunger might facilitate restricted eating
AN < HCs (hunger): right visual occipital cortex
Schienle et al. (2009)
Food vs. nonfood pictures
BED vs. BN vs. HCs vs. overweight
Food > nonfood: OFC, ACC, insula
Differential brain activations in reward circuitry associated with food in patients suffering from BED and BN
BED > overweight, HCs, BN: medial OFC
BN > overweight, HCs, BED: ACC, insula
Stice et al. (2010)
Palatable food vs. unpalatable food vs. neutral food pictures
HCs (from lean to obese)
Palatable food < unpalatable/neutral food: frontal operculum, lateral OFC, striatum predicted > BMI for those with DRD2 TaqIA A1 allele or DRD4-7R allele
Responsivity of reward circuitry to food increases risk for future weight gain, with the moderating effect of genes that impact dopamine signaling capacity
Stice et al. (2011)
Gustatory paradigm (receipt and anticipated receipt of palatable vs. neutral food stimuli)
HCs: high vs. low risk for obesity
High > low-risk obesity (palatable food receipt): caudate, parietal operculum, frontal operculum
Youth at risk for obesity show elevated reward circuitry responsivity in general, coupled with elevated somatosensory region responsivity to food
No differences in response to anticipated food reward
Uher et al. (2003)
Food vs. nonfood pictures
Recovered AN-R vs. AN-R vs. HCs
REC > HCs (food): medial prefrontal cortex, dorsal anterior cingulate, cerebellum
Frontal lobe reactivity could be evaluated as a candidate factor predictive of outcome in AN
REC < HCs (food): left parietal lobule and visual occipital cortex
The brain response in people recovered from AN is a combination of the responses seen in ill patients (medial frontal) and those in HCs (apical and lateral prefrontal)
REC, HCs > AN (food): right lateral PFC, apical PFC, dorsal ACC
AN > REC, HCs (food): superior medial PFC
REC, HCs > AN: apical PFC, bilateral DLPFC, medial paracentral cortex
AN, REC > HCs: medial PFC, cerebellum
Uher et al. (2004)
Food vs. nonfood pictures
AN vs. BN vs. HCs
HCs > EDs (food): left lateral PFC, left parietal cortex, bilateral visual cortex, cerebellum
Abnormal focus of food-related activity in the medial prefrontal region identified in a large number of ED patients
EDs > HCs (food): left medial orbitofrontal and anterior cingulate cortices
ED < HCs (food): lateral PFC, inferior parietal lobule, cerebellum
BN < HCs (food): lateral and apical PFC
van Kuyck et al. (2009)
Review
AN-R
Parietal cortex: <
No specific imaging biomarker or pattern for AN discovered
Anterior and subgenual cingulate cortex: < rest; > symptom provocation
Temporal lobe: symptom provocation: > insula; amygdala
Vocks et al. (2011)
Gustatory paradigm (chocolate vs. hunger vs. satiety)
AN vs. HCs
AN > HCs (chocolate + hunger): amygdala and left medial temporal gyrus
AN: fear response to high-calorie food
HC > AN (chocolate + hunger): right medial frontal gyrus
HC: high reward anticipation
Wagner et al. (2008)
Gustatory paradigm (sugar vs. water)
Recovered AN-R vs. HCs
Recovered AN < HCs: insula, dorsal and middle caudate, dorsal and ventral putamen, anterior cingulate
Individuals recovered from anorexia have disturbances of gustatory processing
AN = HCs: anterioventral striatum, amygdala, and OFC
AN anorexia nervosa, BN bulimia nervosa, BED binge eating disorder, HCs healthy control, ED eating disorder, –R restricting, B/P binge eating and purging, PFC prefrontal cortex, DLPFC dorsolateral PFC, OFC orbitofrontal cortex, ACC anterior cingulate cortex

18.3.1.1 Eating in Anorexia Nervosa

A recent review of neuroimaging studies involving food-related stimuli in EDs concludes that there are altered activations in the parietal and temporal cortices, anterior and subgenual cingulate cortex, and frontal cortex in AN (van Kuyck et al. 2009). A meta-analysis of functional MRI studies using coordinate-based meta-analysis methodology reports increased activation of medial frontal and caudate regions and reduced activation in parietal areas in AN during exposure to food cues (Zhu et al. 2012). In restricting AN, food stimuli are associated with the activity in the brain network responsible for the identification of emotional significance of the stimuli, affective states, and autonomic regulation (e.g., bottom-up processes), including the right amygdala (Joos et al. 2011b), ventral striatum (Wagner et al. 2008), orbitofrontal cortex (Uher et al. 2004), and insular cortex (Uher et al. 2004; Gizewski et al. 2010; Schienle et al. 2009; Vocks et al. 2010). Also, food stimuli are associated with abnormalities in brain areas involved in regulatory processes (e.g., top-down), comprising dorsal regions of the anterior cingulate cortex, posterior cingulate cortex (Gizewski et al. 2010), prefrontal cortex (Pietrini et al. 2011), medial prefrontal cortex (Uher et al. 2004), and dorsolateral prefrontal cortex (Brooks et al. 2011b

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Mar 18, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on The Use of Magnetic Resonance Imaging (MRI) in Eating Disorders

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