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نمایش مقاله

Title:

Does a Targeting Neuroimaging Measure Need to Be a Response or Predictive Measure? Evidence from DLPFC–sgACC Connectivity in TMS for Depression

Subject:

Advanced Techniques in Signal Acquisition and Image Processing

Presenter Author:
Name:	Seyed Mahan Mohajerani

Author:
Name 1:	Seyed Mahan Mohajerani - Presenter
Affiliation 1:	Neurocognitive Lab, Iranian National Center for Addiction Studies (INCAS), Tehran, Iran

Name 2:	Melina Mehrad-Ayin
Affiliation 2:	Neurocognitive Lab, Iranian National Center for Addiction Studies (INCAS), Tehran, Iran

Name 3:	Arash Khojasteh-Zonoozi
Affiliation 3:	Neurocognitive Lab, Iranian National Center for Addiction Studies (INCAS), Tehran, Iran

Name 4:	Mehran Zare-Bidoky - Corresponding
Affiliation 4:	Neurocognitive Lab, Iranian National Center for Addiction Studies (INCAS), Tehran, Iran

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Abstract

Original Research

introduction :

Dorsolateral prefrontal cortex–subgenual anterior cingulate cortex (DLPFC–sgACC) connectivity is increasingly used to guide transcranial magnetic stimulation (TMS) targeting in depression. However, it remains unclear whether a neuroimaging measure can be clinically useful for target selection without also changing with treatment or reflecting treatment response.

Methods:

We conducted a literature search from inception through August 2026 and included studies evaluating DLPFC–sgACC connectivity in the context of TMS targeting in depression, either prospectively to select the stimulation target or retrospectively as a clinically applicable targeting measure. Each study was coded separately for four neuroimaging roles—targeting, diagnostic, predictive, and response—as positive, negative, or not tested. Targeting referred to the use of DLPFC–sgACC connectivity to identify the stimulation target; diagnostic to its ability to distinguish patients from healthy individuals or relevant comparison groups; predictive to whether the magnitude of pretreatment connectivity predicted treatment outcome; and response to whether connectivity changed following TMS. Prospective individualized targeting was coded only when a participant-specific DLPFC target was derived from pretreatment fMRI and subsequently stimulated.

Results:

After screening, 23 studies met the inclusion criteria. Targeting evidence was positive in 21 studies. All 11 studies that prospectively derived individualized DLPFC targets from pretreatment fMRI reported positive targeting findings, whereas the 2 studies reporting negative findings were both retrospective evaluations of DLPFC–sgACC targeting. DLPFC–sgACC connectivity was evaluated as a response measure in 4 studies, i.e., whether connectivity changed after TMS; all reported findings were negative. Evidence for predictive utility, i.e., whether the magnitude of pretreatment DLPFC–sgACC connectivity predicted treatment outcome, was less consistent, with positive findings in 2 of 5 studies and negative findings in 3. Diagnostic evidence for DLPFC-sgACC connectivity in distinguishing groups was examined in 3 studies, with 2 reporting positive and 1 negative findings.

Conclusion:

Across studies examining DLPFC–sgACC connectivity in the context of TMS targeting for depression, evidence supporting its role in target selection was predominantly positive, whereas evidence that connectivity changed following TMS was mixed. This dissociation suggests that targeting and response represent distinct neuroimaging roles: a measure can be clinically useful for identifying where to stimulate without necessarily changing with treatment or serving as a marker of treatment response. Thus, modulation of a targeting measure should not be assumed to be necessary for its clinical utility.

Keywords:

Neuroimaging; Transcranial Magnetic Stimulation; Depressive Disorder; Magnetic Resonance Imaging; Brain Mapping; Treatment Outcome