Differentiating Schizophrenia from Bipolar Illness on 18 F FDG PET CT Based on white Matter Metabolism; an under-Utilised Parameter

Abstract

18F-FDG PET/CT positron emission tomography studies (FDG-PET) have shown similar cortico-limbic metabolic dysregulation in bipolar disorder and schizophrenia, with hypoactive prefrontal cortex coupled with hyperactive anterior limbic areas. However, it is not clear whether white matter metabolism connecting these regions is differently affected in the two disorders. Forty eight patients with schizophrenia mean age ± S.D] 31.6 ± 7.8 and 56 patients with bipolar disorder [mean age±S.D] 46.2 ± 8.9 underwent an 18F-FDG PET/CT scan. Normalized datasets the two groups of patients were compared on a voxel-by-voxel basis using a two-sample t statistic test as implemented in SPM8, and adding age as covariate. Group differences were assessed applying a threshold of p<0.0005. White matter metabolic rates significantly differed between schizophrenia and bipolar disorder, whereas no differences were shown for cortical activity. This is the first 18F-FDG PET/CT to our best knowledge, directly comparing subjects with schizophrenia to those with bipolar disorder. It reports decreased activity in the center of large fronto-temporal and cerebellar white matter tracts in patients with schizophrenia in respect to those with bipolar disorder. This feature may characterize and differentiate the regional brain metabolism of the two illnesses.