Treatment class | Evidence | Author | Year | Neuroimaging | Subjects | Age category | Treatment | Region of analysis | ||||||
OCD | HC | Caudate | OFC | PFC | ACC | Thalamus | Other | |||||||
Pharmaco-therapy | Metabolic | Baxter | 1992 | PET | 9 | 4 | Adult | Fluoxetine | ↓(R) | |||||
Swedo | 1992 | PET | 13 | 0 | Adult | Clomipramine or Fluoxetine | ↓ | |||||||
Perani | 1995 | PET | 11 | 15 | Adult | Various SSRI or Clomipramine | ↓ | ↓middle, posterior cingulate | ||||||
Hansen | 2002 | PET | 20 | 11 | Adult | Paroxetine | ↓(R) | |||||||
Apostolova | 2010 | PET | 7 | 0 | Adult | Paroxetine | ↑(R) | |||||||
Perfusion | Hendler | 2003 | SPECT | 26 | 0 | Adult | Sertraline | ↑(L)anterior middle temporal gyrus | ||||||
Ho-Pian | 2005 | SPECT | 15 | 0 | Adult | Fluvoxamine | ↓(R) | |||||||
Karadağ | 2013 | SPECT | 12 | 10 | Adult | SSRI+Risperidone | ↑ | |||||||
Neurochemical | Rosenberg | 2000 | H-MRS | 11 | 11 | Paediatric | Paroxetine | ↓(L)(Glx) | ||||||
Lissemore | 2018 | 5-HT synthesis PET | 8 | 0 | Adult | Sertraline | ↑global 5-HT synthesis capacity | |||||||
Structural | Gilbert | 2000 | Volumetric MRI | 10 | 8 | Paediatric | Paroxetine | ↓ | ||||||
Lázaro | 2009 | Volumetric MRI | 15 | 15 | Paediatric | Fluoxetine* | ↑parietal lobe | |||||||
Functional | Han | 2011 | task fMRI | 10 | 20 | Adult | Escitalopram or Fluoxetine | ↑(L) | ↑(R)insula | |||||
CBT | Metabolic | Baxter | 1992 | PET | 9 | 4 | Adult | E/RP | ↓(R) | |||||
Saxena | 2009 | PET | 10 | 12 | Adult | E/RP* (Foa) | ↑(R) | |||||||
Apostolova | 2010 | PET | 9 | 0 | Adult | E/RP (Foa) | ↑(R) | |||||||
Lissemore | 2018 | 5-HT synthesis PET | 8 | 0 | Adult | E/RP | ↑ Global 5-HT synthesis capacity | |||||||
Perfusion | Yamanishi | 2009 | SPECT | 45 | 0 | Adult | E/RP* (Iikura) | ↓(R) | ||||||
Neurochemical | Whiteside | 2012 | H-MRS | 15 | 15 | Adult | E/RP* | ↑(L)(NAA) | ↑(R)(tNAA) | |||||
Structural | Huyser | 2013 | Volumetric MRI | 26 | 27 | Paediatric | E/RP (Haan, Wolters et al) | ↑(L) | ||||||
Atmaca | 2018 | Volumetric MRI | 12 | 12 | Adult | E/RP | ↑(L) | ↓ | ||||||
Zhong | 2019 | DWI-FA | 85 | 90 | Adult | E/RP | ↑(L) | (L)MTG ↓ (R)putamen ↑ | ||||||
Functional | Huyser | 2010 | task fMRI | 24 | 25 | Paediatric | E/RP (Haan, Wolters et al) | ↑(L) | ↑(L)parietal cortex | |||||
Li | 2018 | rs-fMRI | 20 | 20 | Adult | E/RP | ↓(L) | |||||||
Lesion | Metabolic | Zuo | 2013 | PET | 8 | 8 | Ages 16 to 29 | capsulotomy | ↓ (SMA) | ↓ | ↑(R)occipital gyrus | |||
Suetens | 2014 | PET | 13 | 26 | Adult | capsulotomy | ↑ occipital cortex | |||||||
Functional | Yin | 2018 | rs-fMRI | 27 | 29 | Adult | capsulotomy | ↓ | ↓NAcc | |||||
DBS | Metabolic | Van Laere | 2006 | PET | 6 | 20 | Adult | ALIC | ↓ NAcc,(L)hippocampus,(L)PCC | |||||
Le Jeune | 2010 | PET | 10 | 10 | Adult | STN | ↓ | ↓ | ||||||
Lee | 2019 | FDG-PET | 2 | 0 | Adult | Inferior thalamic peduncle | ↓(R) | ↑(L) | ↓(R) | ↓(R)putamen, SMA. ↑ M1,(L)temporal pole. | ||||
Park | 2019 | FDG-PET | 2 | 0 | Adult | NAcc | ↓ | ↓ | ||||||
Perfusion | Figee | 2014 | SPECT | 15 | 15 | Adult | NAcc | ↓ areas surrounding the NAcc | ||||||
Functional | Figee | 2013 | rsfMRI | 9 | 13 | Adult | NAcc | ↓ | ↓NAcc | |||||
TMS | Metabolic | Nauczyciel | 2014 | PET | 19 | 0 | Adult | 1 Hz @ R. OFC | ↓(R) |
Summary of neuroimaging results that correlated with improvement in behaviour as measured by Yale-Brown Obsessive Compulsive Scale. Studies are separated by treatment class, then by evidence type. Subject numbers included only patients analysed at both preintervention and postintervention time points. Region of analysis indicators demonstrate direction of reported significant change, and when unilateral, the side is indicated as (R) for right and (L) for left hemispheres.
*Pharmacotherapy and CBT/ERP treatment classes were used simultaneously.
ACC, anterior cingulate cortex; ALIC, anterior limb of the internal capsule; CBT/ERP, cognitive–behavioural therapy/exposure and response prevention; DBS, deep brain stimulation; E/RP, exposure and response prevention; FDG, fluoro-deoxyglucose; fMRI, functional MRI; Glx, glutamate concentration; 5-HT, serotonin or 5-hydroxytryptamine; LFP, local field potential; M1, primary motor area; MCC, mid-cingulate cortex; MTG, middle temporal gyrus; NAA, N-acetylaspartate; NAcc, nucleus accumbens; OFC, orbitofrontal cortex; PCC, posterior cingulate cortex; PET, positron emission tomography; PFC, prefrontal cortex; rs-fMRI, resting-state functional magnetic resonance imaging; SMA, supplementary motor area; SPECT, single photon emission CT; SSRIs, selective serotonin reuptake inhibitors; STN, subthalamic nucleus; TMS, transcranial magnetic stimulation; tNAA, total N-acetylaspartate.;