Regional cerebral blood flow during auditory recall in 47 subjects exposed to assaultive and non–ssaultive trauma and developing or not posttraumatic stress disorder

  • M. Pagani
  • G. Högberg
  • D. Salmaso
  • B. Tarnell
  • A. Sanchez–Crespo
  • J. Soares
  • A. Åberg–Wistedt
  • H. Jacobsson
  • T. Hällström
  • S. A. Larsson
  • Ö. Sundin



Psychological trauma leads to posttraumatic stress disorder (PTSD) in susceptible subjects. The aim of this study was to investigate the differences in regional cerebral blood flow (rCBF) between two groups of subjects exposed to different types of traumatic stressor either developing or not developing PTSD.


Twenty subjects developing (S) and 27 not developing (NS) PTSD after being exposed to either earlier person–under–the–train accident (NA) or being assaulted in the underground environment (A) were included in the study. 99mTc–HMPAO SPECT was performed and the uptake in 29 regions of the brain (VOIs), bilaterally, was assessed. rCBF distribution was compared, using analysis of variance (ANOVA), between groups (S/NS) and type (A/NA) during a situation involving an auditory evoked re–experiencing of the traumatic event. Discriminant analysis was applied to test the concordance between clinical diagnosis and SPECT findings.


In the general analyses significant differences were found between groups and types and there was a significant hemisphere × type interaction. S showed higher CBF than NS and so did A as compared to NA, particularly in the right hemisphere. Discriminant analysis correctly classified 66% of cases (p < 0001) in testing S/NS and 72% (p < 0001) in testing NA/A.


Under recall of their traumatic experience we found higher relative CBF distribution values in S as compared to NS. CBF was higher in the right hemisphere and particularly in assaulted subjects. These findings underscore the role upon trauma recall of both the right hemisphere and the nature of the stressing event.

Key words

PTSD assaultive trauma SPECT rCBF 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bonne O, Louzoun Y, Aharon I, Krausz Y, Karger H, Lerer B, Bocher M, Freedman N, Chisin R (2003) Cerebral blood flow in depressed patients: a methodological comparison of statistical parametric mapping and region of interest analyses. Psychiatry Res 122:49–57PubMedGoogle Scholar
  2. 2.
    Bremner JD, Narayan M, Staib LH, Southwick SM, McGlashan T, Charney DS (1999) Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. Am J Psychiatry 156:1787–1795PubMedGoogle Scholar
  3. 3.
    Bremner JD, Staib LH, Kaloupek D (1999) Neural correlates of exposure to traumatic pictures and sound in vietnam combat veterans with and without posttraumatic stress disorder: a positron emission tomography study. Biol Psychiatry 45:806–816CrossRefPubMedGoogle Scholar
  4. 4.
    Bremner JD (2002) Neuroimaging studies in post-traumatic stress disorder. Curr Psychiatry Rep 4:254–263PubMedGoogle Scholar
  5. 5.
    Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community. Arch Gen Psychiatry 55:626–632CrossRefPubMedGoogle Scholar
  6. 6.
    Breslau N (2001) The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatry 62(Suppl 17):16–22Google Scholar
  7. 7.
    Brewin CR, Andrews B, Rose S, Kirk M (1999) Acute stress disorder and posttraumatic stress disorder in victims of violent crime. Am J Psychiatry 156:360–366PubMedGoogle Scholar
  8. 8.
    Corballis M (2003) From mouth to hand: Gestures, speech and the evolution of right-handedness. Behav Brain Sci 26:199–260CrossRefPubMedGoogle Scholar
  9. 9.
    Damasio AR, Grabowski TJ, Bechara A, Damasio H, Ponto LL, Parvizi J, Hichwa RD (2000) Subcortical and cortical brain activity during the feeling of self-generated emotions. Nature Neurosci 3:1049–1056CrossRefPubMedGoogle Scholar
  10. 10.
    Davidson JRT, Tharwani HM, Connor KM (2002) Davidson Trauma Scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety 15:75–78CrossRefPubMedGoogle Scholar
  11. 11.
    Friston KJ, Frith CD, Liddle PF, Frackowiak RS (1991) Comparing functional (PET) images: The assessment of significant changes. J Cereb Blood Flow Metab 11:690–699PubMedGoogle Scholar
  12. 12.
    Gainotti G (2001) Disorders of emotional behaviour. J Neurol 248:743–749 CrossRefPubMedGoogle Scholar
  13. 13.
    Greitz T, Bohm C, Holte S, Eriksson L (1991) A computerized brain atlas: construction, anatomical content, and some applications. J Comput Assist Tomogr 53:26–38Google Scholar
  14. 14.
    Heller W, Koven NS, Miller GA (2003) Regional brain activity in anxiety and depression, cognition/emotion interaction, and emotional regulation. In: Hugdahl K, Davidsson RJ (eds) The asymmetrical brain. Bradford, London, pp 533–564Google Scholar
  15. 15.
    Hull AM (2002) Neuroimaging findings in post-traumatic stress disorder. Br J Psychiatry 181:102–110CrossRefPubMedGoogle Scholar
  16. 16.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060 PubMedGoogle Scholar
  17. 17.
    Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61(Suppl 5):4–12Google Scholar
  18. 18.
    Lang PJ, Levin DN, Miller GA, Kozak MJ (1983) Fear behaviour, fear imagery, and the psychophysiology of emotion: the problem of affective response integration. J Abn Psychol 92:276–306CrossRefGoogle Scholar
  19. 19.
    Liberzon I, Taylor SF, Amdur R, Jung TD, Chamberlain KR, Minoshima S, Koeppe RA, Fig LM (1999) Brain Activation in PTSD in response to Trauma-Related Stimuli. Biol Psychiatry 45:817–826CrossRefPubMedGoogle Scholar
  20. 20.
    March JS (1993) What constitutes a stressor? The “Criterion A” issue. In:Davidsson JRT, Foa EB (eds) Post-Traumatic Stress Disorder: DSM-IV and Beyond. American Press, Washington DC, pp 37–54Google Scholar
  21. 21.
    Mcquaid JR, Pedrelli P, McCahill ME, Stein MB (2001) Reported trauma, post-traumatic stress disorder and major depression among primary care patients. Psychol Med 31:1249–1257CrossRefPubMedGoogle Scholar
  22. 22.
    Mollica RF, McInnes K, Poole C, Tor S (1998) Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. Br J Psychiatry 173:482–488PubMedGoogle Scholar
  23. 23.
    Pagani M, Salmaso D, Nardo D, Jonsson C, Danielsson AM, Jacobsson H, Larsson SA (2004) Accuracy of possible and probable Alzheimer disease diagnosis: a methodological comparison using SPM and principal component analysis. Eur J Nuc Med 31(8):S218Google Scholar
  24. 24.
    Pissiota A, Frans O, Fernandez M, von Knorring L, Fischer H, Fredrikson M (2002) Neurofunctional correlates of posttraumatic stress disorder: a PET symptom provocation study. Eur Arch Psychiatry Clin Neurosci 252:68–75CrossRefPubMedGoogle Scholar
  25. 25.
    Pitman RK, Orr SP, Forgue DF, de Jong JB, Claiborn JM (1987) Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry 44:970–975PubMedGoogle Scholar
  26. 26.
    Pizzagalli D, Shackman AJ, Davidsson RJ (2003) The functional neuroimaging of human emotion: asymmetrical contributions of cortical and subcortical circuitry. In:Hugdahl K, Davidsson RJ (eds) The asymmetrical brain. Bradford, London, pp 511–532Google Scholar
  27. 27.
    Rauch SL, Savage CR, Alpert NM, Fischman AJ, Jenike MA (1997) The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biol Psychiatry 42:446–452CrossRefPubMedGoogle Scholar
  28. 28.
    Rauch SL, van der Kolk BA, Fisler RE, Alpert NM, Orr SP, Savage CR, Fischman AJ, Jenike MA, Pitman RK (1996) A symptom provocation study using Positron emission tomography and Script Driven Imagery. Arch Gen Psychiatry 53:380–387PubMedGoogle Scholar
  29. 29.
    Shalev AY (2001) What is post traumatic stress disorder? J Clin Psychiatry 62(Suppl):4–10Google Scholar
  30. 30.
    Shin LM, Kosslyn SM, McNally RJ, Alpert NM, Thompson WL, Rauch SL, Macklin ML, Pitman RK (1997) Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation. Arch Gen Psychiatry 54:233–241PubMedGoogle Scholar
  31. 31.
    Shin LM, McNally RJ, Kosslyn SM, Thompson WL, Rauch SL, Alpert NM, Metzger LJ, Lasko NB, Orr SP, Pitman RK (1999) Regional cerebral blood flow during script-driven imagery in childhood sexual abuse-related PTSD:A PET investigation. Am J Psychiatry 156:575–584PubMedGoogle Scholar
  32. 32.
    Stein MB, Walker JR, Forde DR (2000) Gender differences in susceptibility to posttraumatic stress disorder. Behav Res Ther 38:619–628CrossRefPubMedGoogle Scholar
  33. 33.
    Thurfjell L, Bohm C, Bengtsson E (1995) CBA – an atlas based software tool used to facilitate the interpretation of neuroimaging data. Comput Meth Programs Biomed 4:51–71CrossRefGoogle Scholar
  34. 34.
    Tucker DM (1987) Hemispheric specialization: a mechanism for unifying anterior and posterior brain regions. In:Ottoson D (ed) Duality and unity of the Brain. MacMillan Press, London, pp 180–193Google Scholar
  35. 35.
    Van der Kolk B (1997) The psychobiology of posttraumatic stress disorder. J Clin Psychiatry 58(Supp 9):16–24Google Scholar
  36. 36.
    Zubieta JK, Chinitz JA, Lombardi U, Fig LM, Cameron OG, Liberzon I (1999) Medial frontal cortex involvement in PTSD symptoms: A SPECT study. J Psychiatr Res 33:259–264CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • M. Pagani
    • 1
    • 2
  • G. Högberg
    • 3
  • D. Salmaso
    • 2
  • B. Tarnell
    • 3
  • A. Sanchez–Crespo
    • 1
  • J. Soares
    • 4
  • A. Åberg–Wistedt
    • 4
  • H. Jacobsson
    • 1
  • T. Hällström
    • 3
  • S. A. Larsson
    • 1
  • Ö. Sundin
    • 4
  1. 1.Section of Nuclear Medicine and Dept. of Radiology Karolinska HospitalStockholmSweden
  2. 2.Institute of Cognitive Sciences and Technologies, CNRRomeItaly
  3. 3.NEUROTEC, Division of Psychiatry Karolinska Institutet Huddinge, University HospitalStockholmSweden
  4. 4.Dept. of Clinical Neuroscience Karolinska Institutet, Karolinska HospitalStockholmSweden

Personalised recommendations