Decreased uncinate fasciculus tract integrity in male and female patients with PTSD: a diffusion tensor imaging study

Decreased uncinate fasciculus tract integrity in male and female patients with PTSD: a diffusion tensor imaging study

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J Psychiatry Neurosci 2017;42(5):331-342

Saskia B.J. Koch, PhD; Mirjam van Zuiden, PhD; Laura Nawijn, MSc; Jessie L. Frijling, PhD; Dick J. Veltman, PhD; Miranda Olff, PhD


Background: Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder that has been associated with lower white matter integrity of tracts connecting the prefrontal cortex with limbic regions. However, previous diffusion tensor imaging (DTI) findings have been inconsistent, showing high variability in the exact location and direction of effects.

Methods: We performed probabilistic tractography of the bilateral uncinate fasciculus, cingulum and superior longitudinal fasciculus (both temporal and parietal projections) in male and female police officers with and without PTSD.

Results: We included 38 (21 men) police officers with and 39 (20 men) without PTSD in our analyses. Compared with trauma-exposed controls, patients with PTSD showed significantly higher mean diffusivity of the right uncinate fasciculus, the major white matter tract connecting the amygdala to the prefrontal cortex (p = 0.012). No other significant between-group or group × sex differences were observed. Mean diffusivity of the right uncinate fasciculus was positively associated with anxiety symptoms (r = 0.410, p = 0.013) in patients with PTSD as well as with amygdala activity (r = 0.247, p = 0.038) and ventromedial prefrontal cortex (vmPFC) activity (r = 0.283, p = 0.016) in all participants in response to happy and neutral faces.

Limitations: Our specific sample of trauma-exposed police officers limits the generalizability of our findings to other PTSD patient groups (e.g., civilian trauma).

Conclusion: Patients with PTSD showed diminished structural connectivity between the amygdala and vmPFC, which was correlated with higher anxiety symptoms and increased functional activity of these brain regions. Our findings provide additional evidence for the prevailing neurocircuitry model of PTSD, postulating that ineffective communication between the amygdala and vmPFC underlies decreased top–down control over fear responses.

Submitted July 1, 2016; Revised Nov. 30, 2016; Revised Jan. 11, 2017; Accepted Jan. 14, 2017; Early-released Apr. 28, 2017

Acknowledgements: The authors thank all individuals who participated in this study. The authors thank all personnel of the PDC police outpatient clinic for their valuable help with recruitment of the patients with PTSD. The study is supported by grants from ZonMw, the Netherlands organization for Health Research and Development (grant no. 40-00812-98-10041) and the Academic Medical Center Research Council (110614).

Affiliations: From the Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (Koch, van Zuiden, Nawijn, Frijling, Olff); the Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands (Koch, Nawijn, Frijling); the Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Veltman); the Arq Psychotrauma Expert Center, Diemen, the Netherlands (Olff); and the Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands (Koch).

Competing interests: None declared.

Contributors: All authors designed the study. S. Koch and L. Nawijn acquired the data, which all authors analyzed. S. Koch wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.160129

Correspondence to: S. Koch, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands;