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Am J Psychiatry 1995; 152:1139-1144
Copyright © 1995 by American Psychiatric Association
T2 hyperintensities in bipolar disorder: magnetic resonance imaging comparison and literature meta-analysis
LL Altshuler, JG Curran, P Hauser, J Mintz, K Denicoff and R Post
Department of Psychiatry and Biobehavioral Sciences, UCLA Center for Health Sciences, USA.
OBJECTIVE: Accumulating evidence suggests a greater number of T2
abnormalities in the brains of patients with bipolar I disorder. The
authors sought to evaluate the presence of signal "hyperintensities" in
both bipolar I and II subjects and systematically review the existing
literature. METHOD: Magnetic resonance images of the brain were obtained
prospectively for 29 patients with bipolar I disorder, 26 patients with
bipolar II disorder, and 20 normal comparison subjects. The presence and
location of signal hyperintensities in three brain regions (periventricular
white matter, subcortical gray matter, and deep white matter) were
evaluated. RESULTS: No significant differences were found between groups
for the presence of subcortical gray or deep white matter hyperintensities.
Periventricular hyperintensities were more common in bipolar I patients
(62%) than in bipolar II patients (38%) and normal comparison subjects
(30%). Within patient groups, medication use was not significantly
different for those with or without the presence of white matter
hyperintensities. The literature on bipolar disorder and signal
hyperintensities is reviewed. A meta- analysis of the pooled data in the
literature on bipolar illness and signal hyperintensities revealed that the
odds of having a T2 hyperintensity are significantly greater for bipolar I
than for normal comparison subjects. CONCLUSIONS: Having bipolar I disorder
significantly increases the chance of having white matter changes in the
brain. This study suggests that bipolar II patients may be more similar
than bipolar I patients to comparison subjects on T2 measures. The possible
pathophysiological significance of hyperintensities is discussed.
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