Nuclear Neuroimaging and Psychosurgery in Obsessive-Compulsive Disorder

  • Jun Soo Kwon
  • Jung-Seok Choi
  • Myung Chul Lee


Nuclear neuroimaging techniques such as PET and SPECT have contributed enormously to the development of the neurobiological model of obsessive-compulsive disorder (OCD). Recently, studies using functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS) in patients with OCD have been increasing in number, but these studies are not reviewed here. To date, based on the existing neuroimaging studies, many researchers have emphasized the role of the frontal cortex and the striatum in the pathophysiology of OCD. In the functional imaging studies, hypermetabolic rates or hyperactivity have been found in the OFC, anterior cingulate cortex, and/or basal ganglia with the patient in a resting state. Activation in similar brain regions has also been found in the case of OCD symptom provocation. Moreover, metabolic rates or blood flows were lowered after pharmacotherapy or behavioural therapy. In addition, surgical intervention disrupting the fronto-subcortical circuitry had an effect on the reduction of the hyperactivity in the components of this circuitry. So far, however, little consideration has been given to the involvement of the parieto-cerebellar dysfunction in the pathophysiology of OCD. Recently, some studies have suggested the involvement of the parieto-cerebellar dysfunction, as well as fronto-subcortical dysfunction in OCD. The parietal dysfunction may be related to visuo-spatial processing and visual memory deficits in some patients with OCD. Also, the cerebellum plays an important role in coordinating complex mental and non-motor higher cognitive functions, and dysfunctions may be related to some cognitive deficits in OCD. Further research will be needed to clarify the involvement of parieto-cerebellar dysfunction in the pathophysiology of OCD.


Major Depressive Disorder Regional Cerebral Blood Flow Single Photon Emission Compute Tomography Study Orbital Gyrus Orbital Frontal Cortex 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Adams BL, Warneke LB, McEwan AJ, Fraser BA (1993) Single photon emission computerized tomography in obsessive compulsive disorder: a preliminary study. J Psychiatry Neurosci 18: 109–112PubMedGoogle Scholar
  2. Baxter LR Jr, Phelps ME, Mazziotta JC, Guze BH, Schwartz JM, Selin CE(1987) Local cerebral glucose metabolic rates in obsessive-compulsive disorder. A comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry 44:211–218Google Scholar
  3. Baxter LR Jr, Schwartz JM, Mazziotta JC, Phelps ME, Pahl JJ, Guze BH, Fairbanks L (1988) Cerebral glucose metabolic rates in nondepressed patients with obsessive-compulsive disorder. Am J Psychiatry 145:1560–1563PubMedGoogle Scholar
  4. Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, Alazraki A, Selin CE, Ferng HK, Munford P (1992) Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry 49:681–689PubMedCrossRefGoogle Scholar
  5. Benkelfat C, Nordahl TE, Semple WE, King AC, Murphy DL, Cohen RM (1990) Local cerebral glucose metabolic rates in obsessive-compulsive disorder. Patients treated with clomipramine. Arch Gen Psychiatry 47:840–848PubMedCrossRefGoogle Scholar
  6. Biver F, Goldman S, Francois A, De La Porte C, Luxen A, Gribomont B, Lotstra F (1995) Changes in metabolism of cerebral glucose after stereotactic leukotomy for refractory obsessive-compulsive disorder: a case report. J Neurol Neurosurg Psychiatry 58:502–505PubMedCrossRefGoogle Scholar
  7. Brody AL, Saxena S, Schwartz JM, Stoessel PW, Maidment K, Phelps ME, Baxter LR Jr (1998) FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Res 84:1–6PubMedCrossRefGoogle Scholar
  8. Busatto GF, Zamignani DR, Buchpiguel CA, Garrido GE, Glabus MF, Rocha ET, Maia AF, Rosario-Campos MC, Campi Castro C, Furuie SS, Gutierrez MA, McGuire PK, Miguel EC (2000) A voxel-based investigation of regional cerebral blood flow abnormalities in obsessive-compulsive disorder using single photon emission computed tomography (SPECT). Psychiatry Res 99:15–27PubMedCrossRefGoogle Scholar
  9. Cottraux J, Gerard D, Cinotti L, Froment JC, Deiber MP, Le Bars D, Galy G, Millet P, Labbe C, Lavenne F, Bouvard M, Mauguiere F (1996) A controlled positron emission tomography study of obsessive and neutral auditory stimulation in obsessive-compulsive disorder with checking rituals. Psychiatry Res 60:101–112PubMedCrossRefGoogle Scholar
  10. Crespo-Facorro B, Cabranes JA, Lopez-Ibor Alcocer MI, Paya B, Fernandez Perez C, Encinas M, Ayuso Mateos JL, Lopez-Ibor JJ Jr (1999) Regional cerebral blood flow in obsessive-compulsive patients with and without a chronic tic disorder. A SPECT study. Eur Arch Psychiatry Clin Neurosci 249:156–161CrossRefGoogle Scholar
  11. Hansen ES, Hasselbalch S, Law I, Bolwig TG (2002) The caudate nucleus in obsessive-compulsive disorder. Reduced metabolism following treatment with paroxetine: a PET study. Int J Neuropsychopharmacol 5:1–10PubMedCrossRefGoogle Scholar
  12. Hoehn-Saric R, Pearlson GD, Harris GJ, Machlin SR, Camargo EE (1991) Effects of fluoxetine on regional cerebral blood flow in obsessive-compulsive patients. Am J Psychiatry 148:1243–1245PubMedGoogle Scholar
  13. Hoehn-Saric R, Schlaepfer TE, Greenberg BD, McLeod DR, Pearlson GD, Wong SH (2001) Cerebral blood flow in obsessive-compulsive patients with major depression: effect of treatment with sertraline or desipramine on treatment responders and non-responders. Psychiatry Res 108:89–100PubMedCrossRefGoogle Scholar
  14. Hollander E, Prohovnik I, Stein DJ (1995) Increased cerebral blood flow during m-CPP exacerbation of obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci 7:485–490PubMedGoogle Scholar
  15. Kang DH, Kwon JS, Kim JJ, Youn T, Park HJ, Kim MS, Lee DS, Lee MC (2003) Brain glucose metabolic changes associated with neuropsychological improvements after 4 months of treatment in patients with obsessive-compulsive disorder. Acta Psychiatr Scand 107:291–297PubMedCrossRefGoogle Scholar
  16. Kim MC, Lee TK, Son BC, Choi CR, Lee C (2001) Regional cerebral blood flow changes in patients with intractable obsessive compulsive disorders treated by limbic leukotomy. Stereotact Funct Neurosurg 76:249–255PubMedCrossRefGoogle Scholar
  17. Kwon JS, Kim JJ, Lee DW, Lee JS, Lee DS, Kim MS, Lyoo IK, Cho MJ, Lee MC (2003) Neural correlates of clinical symptoms and cognitive dysfunctions in obsessive-compulsive disorder. Psychiatry Res 122:37–47PubMedCrossRefGoogle Scholar
  18. Lucey JV, Costa DC, Blanes T, Busatto GF, Pilowsky LS, Takei N, Marks IM, Ell PJ, Kerwin RW (1995) Regional cerebral blood flow in obsessive-compulsive disordered patients at rest. Differential correlates with obsessive-compulsive and anxious-avoidant dimensions. Br J Psychiatry 167:629–634PubMedCrossRefGoogle Scholar
  19. Lucey JV, Costa DC, Adshead G, Deahl M, Busatto G, Gacinovic S, Travis M, Pilowsky L, Ell PJ, Marks IM, Kerwin RW (1997) Brain blood flow in anxiety disorders. OCD, panic disorder with agoraphobia, and post-traumatic stress disorder on 99mTcHMPAO single photon emission tomography (SPET). Br J Psychiatry 171:346–350CrossRefGoogle Scholar
  20. Machlin SR, Harris GJ, Pearlson GD, Hoehn-Saric R, Jeffery P, Camargo EE (1991) Elevated medial-frontal cerebral blood flow in obsessive-compulsive patients: a SPECT study. Am J Psychiatry 148:1240–1242PubMedGoogle Scholar
  21. Martinot JL, Allilaire JF, Mazoyer BM, Hantouche E, Huret JD, Legaut-Demare F, Deslauriers AG, Hardy P, Pappata S, Baron JC (1990) Obsessive-compulsive disorder: a clinical, neuropsychological and positron emission tomography study. Acta Psychiatr Scand 82:233–242PubMedCrossRefGoogle Scholar
  22. McGuire PK, Bench CJ, Frith CD, Marks IM, Frackowiak RS, Dolan RJ (1994) Functional anatomy of obsessive-compulsive phenomena. Br J Psychiatry 164:459–468PubMedCrossRefGoogle Scholar
  23. Molina V, Montz R, Martin-Loeches M, Jimenez-Vicioso A, Carreras JL, Rubia FJ (1995) Drug therapy and cerebral perfusion in obsessive-compulsive disorder. J Nucl Med 36:2234–2238PubMedGoogle Scholar
  24. Nordahl TE, Benkelfat C, Semple WE, Gross M, King AC, Cohen RM (1989) Cerebral glucose metabolic rates in obsessive compulsive disorder. Neuropsychopharmacology 2:23–28PubMedCrossRefGoogle Scholar
  25. Perani D, Colombo C, Bressi S, Bonfanti A, Grassi F, Scarone S, Bellodi L, Smeraldi E, Fazio F (1995) [18F]FDG PET study in obsessive-compulsive disorder. A clinical/metabolic correlation study after treatment. Br J Psychiatry 166:244–250PubMedCrossRefGoogle Scholar
  26. Rauch SL, Jenike MA, Alpert NM, Baer L, Breiter HC, Savage CR, Fischman AJ (1994) Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry 51:62–70PubMedCrossRefGoogle Scholar
  27. Rauch SL, Dougherty DD, Cosgrove GR, Cassem EH, Alpert NM, Price BH, Nierenberg AA, Mayberg HS, Baer L, Jenike MA, Fischman AJ (2001) Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive compulsive disorder. Biol Psychiatry 50:659–667PubMedCrossRefGoogle Scholar
  28. Rauch SL, Shin LM, Dougherty DD, Alpert NM, Fischman AJ, Jenike MA (2002) Predictors of fluvoxamine response in contamination-related obsessive compulsive disorder: a PET symptom provocation study. Neuropsychopharmacology 27:782–791PubMedCrossRefGoogle Scholar
  29. Rubin RT, Villanueva-Meyer J, Ananth J, Trajmar PG, Mena I (1992) Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive-compulsive disorder and matched normal control subjects. Determination by high-resolution single-photon emission computed tomography. Arch Gen Psychiatry 49:695–702Google Scholar
  30. Rubin RT, Ananth J, Villanueva-Meyer J, Trajmar PG, Mena I (1995) Regional 133xenon cerebral blood flow and cerebral 99mTc-HMPAO uptake in patients with obsessive-compulsive disorder before and during treatment. Biol Psychiatry 38:429–437PubMedCrossRefGoogle Scholar
  31. Sachdev P, Trollor J, Walker A, Wen W, Fulham M, Smith JS, Matheson J (2001) Bilateral orbitomedial leucotomy for obsessive-compulsive disorder: a single-case study using positron emission tomography. Aust N Z J Psychiatry 35:684–690PubMedCrossRefGoogle Scholar
  32. Sawle GV, Hymas NF, Lees AJ, Frackowiak RS (1991) Obsessional slowness. Functional studies with positron emission tomography. Brain 114:2191–2202Google Scholar
  33. Saxena S, Brody AL, Maidment KM, Dunkin JJ, Colgan M, Alborzian S, Phelps ME, Baxter LR Jr (1999) Localized orbitofrontal and subcortical metabolic changes and predictors of response to paroxetine treatment in obsessive-compulsive disorder. Neuropsychopharmacology 21:683–693PubMedCrossRefGoogle Scholar
  34. Saxena S, Brody AL, Ho ML, Alborzian S, Ho MK, Maidment KM, Huang SC, Wu HM, Au SC, Baxter LR Jr (2001) Cerebral metabolism in major depression and obsessive-compulsive disorder occurring separately and concurrently. Biol Psychiatry 50:159–170PubMedCrossRefGoogle Scholar
  35. Saxena S, Brody AL., Ho ML, Alborzian S, Maidment KM, Zohrabi N, Ho MK, Huang SC, Wu HM, Baxter LR Jr (2002) Differential cerebral metabolic changes with paroxetine treatment of obsessive-compulsive disorder vs major depression. Arch Gen Psychiatry 59:250–261PubMedCrossRefGoogle Scholar
  36. Schwartz JM, Stoessel PW, Baxter LR Jr, Martin KM, Phelps ME (1996) Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 53:109–113PubMedCrossRefGoogle Scholar
  37. Swedo SE, Schapiro MB, Grady CL, Cheslow DL, Leonard HL, Kumar A, Friedland R, Rapoport SI, Rapoport JL (1989) Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Arch Gen Psychiatry 46:518–523PubMedCrossRefGoogle Scholar
  38. Swedo SE, Pietrini P, Leonard HL, Schapiro MB, Rettew DC, Goldberger EL, Rapoport SI, Rapoport JL, Grady CL (1992) Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Revisualization during pharmacotherapy. Arch Gen Psychiatry 49:690–694CrossRefGoogle Scholar
  39. Zohar J, Insel TR, Berman KF, Foa EB, Hill JL, Weinberger DR (1989) Anxiety and cerebral blood flow during behavioral challenge. Dissociation of central from peripheral and subjective measures. Arch Gen Psychiatry 46:505–510PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • Jun Soo Kwon
    • 1
  • Jung-Seok Choi
    • 1
  • Myung Chul Lee
    • 2
  1. 1.Department of PsychiatrySeoul National University HospitalSeoulKorea
  2. 2.Seoul National University HospitalSeoulKorea

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