Macromolecular Proton Fraction Reveals Divergent White Matter Myelination in Bipolar Disorder and Unipolar Recurrent Depression

Recurrent depressive disorder (RDD) and bipolar disorder (BD) are the most common affective disorders worldwide. However, the pathogenesis of these disorders remains far from understood. Macromolecular proton fraction (MPF) mapping is a sensitive and specific quantitative MRI method for the assessment of brain tissue myelination, but its clinical value for affective disorders remains unknown. This cross-sectional study employed fast MPF mapping on a 1.5T MRI scanner using single-point synthetic reference method to investigate myelin abnormalities in white matter of RDD and BD patients. ANOVA revealed a significant main effect of the group (RDD vs. BD vs. 2 age-matched control groups; F (3.76) =7.42, p<0.001, η²=0.227). MPF values were significantly reduced in RDD versus BD patients (p<0.001). BD showed elevated MPF compared to controls (p=0.01). MPF levels showed significant weak-to-moderate correlations with clinical scales of affective disorders. These findings demonstrate divergent cerebral myelination patterns—hypomyelination in RDDversus an increased myelin content in BD. In conclusion, MPF mapping demonstrated a promise as a marker of myelin content changes in affective disorder.