Poster No:
437
Submission Type:
Abstract Submission
Authors:
Ruri Katsunuma1, Tsunehiko Takamura1, Yusuke Sudo2, Rio Kamashita2, Eiji Shimizu2, Koji Matsumoto3, Keiko Ino1, Shin Fukudo4, Yasuhiro Sato4, Nobuhiro Nohara5, Kazuhiro Yoshiuchi6, Masanori Isobe7, Naoki Kodama8, Masatoshi Takahashi8, Satoru Ide9, Kazumasa Okada10, Kazufumi Yoshihara11,12, Shu Takakura12, Motoharu Gondo12, Yoshiya Moriguchi1, Yoshiyuki Hirano2, Atsushi Sekiguchi1
Institutions:
1Department of Behavioral Medicine, NIMH, National Center of Neurology and Psychiatry, Tokyo, Japan, 2Research Center for Child Mental Development, Chiba University, Chiba, Japan, 3Department of Radiology, Chiba University Hospital, Chiba, Japan, 4Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan, 5Department of Psychosomatic Medicine, The University of Tokyo Hospital, Tokyo, Japan, 6Dept. of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The Univ. of Tokyo, Tokyo, Japan, 7Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 8Div. of Psychosomatic Medicine, Dept. of Neurology, Univ. of Occupational and Environmental Health, Kitakyushu, Japan, 9Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan, 10Department of Neurology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan, 11Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan, 12Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
First Author:
Ruri Katsunuma
Department of Behavioral Medicine, NIMH, National Center of Neurology and Psychiatry
Tokyo, Japan
Co-Author(s):
Tsunehiko Takamura
Department of Behavioral Medicine, NIMH, National Center of Neurology and Psychiatry
Tokyo, Japan
Yusuke Sudo
Research Center for Child Mental Development, Chiba University
Chiba, Japan
Rio Kamashita
Research Center for Child Mental Development, Chiba University
Chiba, Japan
Eiji Shimizu
Research Center for Child Mental Development, Chiba University
Chiba, Japan
Koji Matsumoto
Department of Radiology, Chiba University Hospital
Chiba, Japan
Keiko Ino
Department of Behavioral Medicine, NIMH, National Center of Neurology and Psychiatry
Tokyo, Japan
Shin Fukudo
Department of Psychosomatic Medicine, Tohoku University Hospital
Sendai, Japan
Yasuhiro Sato
Department of Psychosomatic Medicine, Tohoku University Hospital
Sendai, Japan
Nobuhiro Nohara
Department of Psychosomatic Medicine, The University of Tokyo Hospital
Tokyo, Japan
Kazuhiro Yoshiuchi
Dept. of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The Univ. of Tokyo
Tokyo, Japan
Masanori Isobe
Department of Psychiatry, Graduate School of Medicine, Kyoto University
Kyoto, Japan
Naoki Kodama
Div. of Psychosomatic Medicine, Dept. of Neurology, Univ. of Occupational and Environmental Health
Kitakyushu, Japan
Masatoshi Takahashi
Div. of Psychosomatic Medicine, Dept. of Neurology, Univ. of Occupational and Environmental Health
Kitakyushu, Japan
Satoru Ide
Department of Radiology, University of Occupational and Environmental Health School of Medicine
Kitakyushu, Japan
Kazumasa Okada
Department of Neurology, University of Occupational and Environmental Health School of Medicine
Kitakyushu, Japan
Kazufumi Yoshihara
Center for Health Sciences and Counseling, Kyushu University|Department of Psychosomatic Medicine, Kyushu University Hospital
Fukuoka, Japan|Fukuoka, Japan
Shu Takakura
Department of Psychosomatic Medicine, Kyushu University Hospital
Fukuoka, Japan
Motoharu Gondo
Department of Psychosomatic Medicine, Kyushu University Hospital
Fukuoka, Japan
Yoshiya Moriguchi
Department of Behavioral Medicine, NIMH, National Center of Neurology and Psychiatry
Tokyo, Japan
Yoshiyuki Hirano
Research Center for Child Mental Development, Chiba University
Chiba, Japan
Atsushi Sekiguchi
Department of Behavioral Medicine, NIMH, National Center of Neurology and Psychiatry
Tokyo, Japan
Introduction:
Bulimia Nervosa (BN) is an eating disorder characterized by binge eating, purging or fasting, and concerns related to body shape and weight (American Psychiatric Association, 2022). Cognitive-behavioral therapy (CBT) is the first-line treatment for BN, yet high dropout rates and variable efficacy emphasize the need for a deeper understanding of the mechanisms underlying treatment response. Therefore, identifying neurobiological markers that predict treatment response or track therapeutic changes could enhance personalized interventions. However, recruiting sufficient sample sizes at single sites is challenging due to the nature of BN, as many individuals do not seek consistent treatment. To address this gap, we conducted a multi-site, observational cohort study utilizing CBT and applied inter-scanner harmonization to remove non-biological variability. The goal of this study was to identify predictive and treatment response markers of brain volume changes, focusing on regions associated with interoception, somatosensory processing, and cerebellar function, given their integral roles in bodily signal integration and the regulation of eating behavior.
Methods:
The study involved female patients with BN who underwent CBT. MRI data were collected from six facilities using different MRI scanners. Each participant underwent T1-weighted MRI scans before (pre) and after (post) treatment. To address inter-scanner variability, preprocessing included standardization, smoothing (8 mm FWHM), and voxel-based ComBat Harmonization (Fortin et al., 2018; Maikusa et al., 2021). To assess eating disorder severity, Eating Disorder Examination Questionnaire (EDE-Q), a validated self-report measure capturing core symptoms of eating disorder (Aardoom et al., 2012) was used. Regions of Interest were selected a priori for each marker, based on the prior neural anatomical evidence of BN (e.g., Donnelly et al., 2018).
Two analyses were conducted:
1. Predictive marker analysis:
Data from 37 patients (mean±SD age = 33.48±9.77 years) were used to investigate whether baseline brain volume predicted improvements in EDE-Q global scores (Post-Pre). Anatomical masks for the inferior parietal lobe, postcentral gyrus, and insula were used to examine interoceptive and somatosensory processing regions. Small Volume Correction (SVC) was applied.
2. Treatment response marker analysis:
Data from 41 patients (mean±SD age = 33.51±9.64 years) were used to evaluate correlations between brain volume changes (Post-Pre) and EDE-Q improvements. Given the emerging role of the cerebellum in eating behavior regulation, a cerebellar anatomical mask was employed, and SVC was applied.
Both analyses included EDE-Q scores, age, and total brain volume as covariates. Statistical analyses were conducted using SPM12 with a significance threshold of p < 0.05 (FWE-corrected).
Results:
In the predictive marker analysis, greater baseline brain volume in the left inferior parietal region (MNI x, y, z: −42, −34, 48) was significantly associated with greater reductions in EDE-Q scores post-treatment (p=0.039, FWE-corrected). This finding suggests the potential of this region as a marker of treatment responsiveness. In the treatment response marker analysis, significant associations were observed in the cerebellum (lobule VI/declive) (x, y, z: −30, −64, −20), where reductions in cerebellar volume correlated with higher treatment efficacy (p=0.048, FWE-corrected). Patients with greater cerebellar volume reductions exhibited more substantial symptom improvements, highlighting cerebellar involvement in therapeutic adaptation.
Conclusions:
This study identifies the left inferior parietal region as a predictive marker and the cerebellum as a marker of therapeutic plasticity in BN. These findings provide neurobiological evidence supporting the efficacy of CBT and provide new insights into biomarkers for personalized interventions in BN treatment.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Learning and Memory:
Neural Plasticity and Recovery of Function 2
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Anatomy and Functional Systems
Novel Imaging Acquisition Methods:
Imaging Methods Other
Perception, Attention and Motor Behavior:
Perception: Tactile/Somatosensory
Keywords:
Acquisition
Behavioral Therapy
Cerebellum
Eating Disorders
Morphometrics
MRI
Plasticity
Psychiatric Disorders
Somatosensory
Treatment
1|2Indicates the priority used for review
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Please indicate below if your study was a "resting state" or "task-activation” study.
Other
Healthy subjects only or patients (note that patient studies may also involve healthy subjects):
Patients
Was this research conducted in the United States?
No
Were any human subjects research approved by the relevant Institutional Review Board or ethics panel?
NOTE: Any human subjects studies without IRB approval will be automatically rejected.
Yes
Were any animal research approved by the relevant IACUC or other animal research panel?
NOTE: Any animal studies without IACUC approval will be automatically rejected.
Not applicable
Please indicate which methods were used in your research:
Structural MRI
Behavior
For human MRI, what field strength scanner do you use?
3.0T
Which processing packages did you use for your study?
SPM
Provide references using APA citation style.
References
Aardoom, J. et al. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating behaviors, 13(4), 305-309.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Donnelly, B. (2018). Neuroimaging in bulimia nervosa and binge eating disorder: a systematic review. Journal of Eating Disorders, 6(3), 3.
Fortin, J. et al. (2018). Harmonization of cortical thickness measurements across scanners and sites. NeuroImage, Volume 167, 104-120.
Maikusa, N. et al. (2021). Brain age estimation using support vector regression and harmonization across scanner and site. Medical Imaging Technology, 2021;39:171-5.
No