**3. Results**

Following the initial interview, among the 23 VoR subjects, 13 met the DSM-IV diagnostic criteria for current PTSD and 10 VoR did not meet the criteria for PTSD. Based on the study

Abnormal Brain Density in Victims of Rape with PTSD in Mainland

**3.1 Differences in GMD between VoR with PTSD and HC** 

Table 2. Regions displayed are for p < .005.

Comparison

the areas with increased GMD.

China: A Voxel-Based Analysis of Magnetic Resonance Imaging Study 381

The areas found to have abnormal GMD in VoR with PTSD compared to HC are shown in Figure 1. The cortical areas with decreased GMD in VoR with PTSD compared to HC are listed in Part A of Figure 1. These areas include the left medial frontal cortex (A-1), right medial frontal cortex (A-2), the left middle frontal cortex (A-3), the left middle temporal gyrus (A-4), and the left fusiform cortex (A-5). The areas with increased GMD are listed in Part B of Figure 1, and include the right posterior cingulate cortex (B-1), the left pre-central cortex (B-2), right pre-central cortex (B-3), the left inferior parietal lobule (B-4), right inferior parietal lobule (B-5), and the right post-central cortex (B-6). The MNI coordinates, voxel t values, k values (cluster size > 50), and corresponding Brodmann Areas (BA) are detailed in

Fig. 1. Brain regions showing abnormalities in GMD in VoR with PTSD versus Healthy

Part A shows the cortical areas with decreased gray-matter density (GMD) in Victims of Rape with post-traumatic stress disorder compared to Healthy Comparison. Part B shows

L: left; R: right; mFC: medial prefrontal cortex; MFC: middle frontal cortex; MTG: middle

temporal gyrus; PCC: posterior cingulate cortex; IPL: inferior parietal lobule.

protocol, 13 HC were recruited to match VoR with PTSD. All subjects were scanned with an MRI, however, due to too many head movements during MRI scanning, a total of five subjects (2 PTSD, 2 non-PTSD, and 1 HC) were removed. As a result, the final sample consisted of 11 VoR with PTSD (ages 18-31), 8 VoR without PTSD (ages 23-33), and 12 HC (ages 22-33).

The three groups did not differ significantly on major demographics (i.e., age, height, weight, and educational years). In addition, the average interval between rape trauma and data acquisition did not differ significantly between VoR with and VoR without PTSD. Even so, VoR with PTSD scored significantly higher on PTSD symptomatology (P<0.001) compared to VoR without PTSD and HC. None of the participants in this study received medication prior to neuroimaging acquisition. The results are summarized in Table 1.


VoR, Victims of Rape; PTSD, post-traumatic stress disorder; SD, standard deviation; CM, centimeter; KG, kilogram; Interval, time between raped trauma occurrence and scan; PCL-C, Post-traumatic Stress Disorder Checklist Civilian Version; CAPS, Clinician-Administered PTSD Scale.

Table 1. Demographic and clinical characteristics of VoR with and without PTSD and Healthy Comparison

#### **3.1 Differences in GMD between VoR with PTSD and HC**

380 Neuroimaging for Clinicians – Combining Research and Practice

protocol, 13 HC were recruited to match VoR with PTSD. All subjects were scanned with an MRI, however, due to too many head movements during MRI scanning, a total of five subjects (2 PTSD, 2 non-PTSD, and 1 HC) were removed. As a result, the final sample consisted of 11 VoR with PTSD (ages 18-31), 8 VoR without PTSD (ages 23-33), and 12 HC

The three groups did not differ significantly on major demographics (i.e., age, height, weight, and educational years). In addition, the average interval between rape trauma and data acquisition did not differ significantly between VoR with and VoR without PTSD. Even so, VoR with PTSD scored significantly higher on PTSD symptomatology (P<0.001) compared to VoR without PTSD and HC. None of the participants in this study received medication prior to neuroimaging acquisition. The results are summarized in Table 1.

Comparison (n=12) <sup>F</sup>*t p* PTSD(n=11) Non-PTSD(n=8)

.83 - .45


60.32 - .000

**Age (years)**  Mean 25.55 27.50 26.42 .614 - .55 SD 4.01 4.00 3.45 **Education (years)** 

.91 - .41 SD 1.62 1.92 1.12 **Hight (CM)** 

**Weight (KG)** 

0.41 - .67 SD 4.13 6.19 6.81

**event** raped raped none - - - **Interval (months)** 

**PCL-C score** 

**CAPS score** 


VoR, Victims of Rape; PTSD, post-traumatic stress disorder; SD, standard deviation; CM, centimeter; KG, kilogram; Interval, time between raped trauma occurrence and scan; PCL-C, Post-traumatic Stress

Table 1. Demographic and clinical characteristics of VoR with and without PTSD and

VoR (n=19) Healthy

Mean 14.73 15.63 14.83

Mean 157.82 159.25 160.67

SD 5.44 5.81 4.77

Mean 49.00 51.13 50.88

Mean 45.45 53.50 -

SD 55.68 55.54 -

Mean 60.36 34.63 22.58

SD 8.39 8.96 7.89

Disorder Checklist Civilian Version; CAPS, Clinician-Administered PTSD Scale.

Mean 74.45 15.88 -

(ages 22-33).

**Trauma** 

Healthy Comparison

The areas found to have abnormal GMD in VoR with PTSD compared to HC are shown in Figure 1. The cortical areas with decreased GMD in VoR with PTSD compared to HC are listed in Part A of Figure 1. These areas include the left medial frontal cortex (A-1), right medial frontal cortex (A-2), the left middle frontal cortex (A-3), the left middle temporal gyrus (A-4), and the left fusiform cortex (A-5). The areas with increased GMD are listed in Part B of Figure 1, and include the right posterior cingulate cortex (B-1), the left pre-central cortex (B-2), right pre-central cortex (B-3), the left inferior parietal lobule (B-4), right inferior parietal lobule (B-5), and the right post-central cortex (B-6). The MNI coordinates, voxel t values, k values (cluster size > 50), and corresponding Brodmann Areas (BA) are detailed in Table 2. Regions displayed are for p < .005.

Fig. 1. Brain regions showing abnormalities in GMD in VoR with PTSD versus Healthy Comparison

Part A shows the cortical areas with decreased gray-matter density (GMD) in Victims of Rape with post-traumatic stress disorder compared to Healthy Comparison. Part B shows the areas with increased GMD.

L: left; R: right; mFC: medial prefrontal cortex; MFC: middle frontal cortex; MTG: middle temporal gyrus; PCC: posterior cingulate cortex; IPL: inferior parietal lobule.

Abnormal Brain Density in Victims of Rape with PTSD in Mainland

Greater reduction

Greater increase

173 4.23 27 -10 -35 Right uncus 20,28 0.000 314 5.56 -55 -1 -26 Left middle temporal gyrus 21 0.000

607 6.03 -55 -29 21 Left inferior parietal lobule 40 0.001

MNI coordinates (x, y, z)

<sup>k</sup>Voxel t value

.005, *k>50.* 

with increased GMD.

PTSD

China: A Voxel-Based Analysis of Magnetic Resonance Imaging Study 383

53 5.23 -54 -1 -27 Left fusiform cortex 20 0.000

993 5.31 -48 -8 39 Left pre-central cortex 6,4 0.000

270 3.79 54 -23 33 Right post-central cortex 2 0.000

Table 3. Gray-matter density in VoR with PTSD versus VoR without PTSDVoR, Victims of Rape; PTSD, post-traumatic stress disorder; *k*, cluster size; Regions displayed are for *p* <

Part C shows the cortical areas with decreased gray-matter density (GMD) in Victims of Rape (VoR) with post-traumatic stress disorder (PTSD) compared to VoR without PTSD. Part D shows the areas

Fig. 3. Brain regions showing abnormalities in GMD in VoR with PTSD versus VoR without

L: left; R: right; MTG: middle temporal gyrus; IPL: inferior parietal lobule.

Region Brodmann

Area

*p*


PTSD, Post-traumatic Stress Disorder; k, cluster size; Regions displayed are for p < .005, k >50.

Table 2. Gray-matter density in Victims of Rape with PTSD versus Healthy Comparison

L: left; R: right; (C-1) Pyramis (x = -9, y = -72, z = -36; k = 519, t = 4.70); (C-2) uvula (x = -4, y = -66, z = - 35; k = 256, t = 4.02); (C-3) declive (x = -6, y = -69, z = -30; k = 213, t = 3.84); and (C-4) nodule (x = -4, y = - 63, z = -31; k = 147, t = 3.93); Coordinates presented are in Montreal Neurological Institute space.

Fig. 2. Significantly increased cerebellum density in VoR with PTSD versus Healthy Comparison

The PTSD Group showed increased cerebellum density compared with controls in the left side, specifically in the pyramis, uvula, declive, and nodule (see Figure 2).

#### **3.2 Differences in GMD between VoR with and without PTSD**

The areas found to have abnormal GMD in VoR with PTSD compared to the VoR without PTSD are shown in Figure 3. The cortical areas with decreased GMD are listed in Part C of Figure 3. These areas include the right uncus (D-1), the left middle temporal gyrus (D-2), and the left fusiform cortex (D-3). The areas with increased GMD are listed in Part D of


398 4.67 -31 54 2 Left middle frontal cortex 10 0.000

240 3.02 -41 -16 55 Left pre-central cortex 4 0.003 343 3.77 42 -18 62 Right pre-central cortex 4,6 0.001

412 4.17 55 -28 35 Right post-central cortex 2,3 0.000

L: left; R: right; (C-1) Pyramis (x = -9, y = -72, z = -36; k = 519, t = 4.70); (C-2) uvula (x = -4, y = -66, z = - 35; k = 256, t = 4.02); (C-3) declive (x = -6, y = -69, z = -30; k = 213, t = 3.84); and (C-4) nodule (x = -4, y = - 63, z = -31; k = 147, t = 3.93); Coordinates presented are in Montreal Neurological Institute space. Fig. 2. Significantly increased cerebellum density in VoR with PTSD versus Healthy

The PTSD Group showed increased cerebellum density compared with controls in the left

The areas found to have abnormal GMD in VoR with PTSD compared to the VoR without PTSD are shown in Figure 3. The cortical areas with decreased GMD are listed in Part C of Figure 3. These areas include the right uncus (D-1), the left middle temporal gyrus (D-2), and the left fusiform cortex (D-3). The areas with increased GMD are listed in Part D of

side, specifically in the pyramis, uvula, declive, and nodule (see Figure 2).

**3.2 Differences in GMD between VoR with and without PTSD** 

Greater reduction

Greater increase

143 3. 85 -968 11 Left medial frontal cortex 10 0.001 318 3.73 4 64 -4 Right medial frontal cortex 10 0.001

51 3.11 -51 7 -26 Left middle temporal gyrus 21 0.003 718 4.75 -31 -82 -18 Left fusiform cortex 19,20 0.000

449 3.57 4 -64 7 Right posterior cingulate 30,23 0.001

64 3.34 -53 -34 21 Left inferior parietal lobule 40 0.002 211 3.77 57 -27 33 Right inferior parietal lobule 40 0.001

PTSD, Post-traumatic Stress Disorder; k, cluster size; Regions displayed are for p < .005, k >50. Table 2. Gray-matter density in Victims of Rape with PTSD versus Healthy Comparison

Region Brodmann

Area *p*

<sup>k</sup>Voxel t value

Comparison

MNI coordinates (x, y, z)


Table 3. Gray-matter density in VoR with PTSD versus VoR without PTSDVoR, Victims of Rape; PTSD, post-traumatic stress disorder; *k*, cluster size; Regions displayed are for *p* < .005, *k>50.* 

Part C shows the cortical areas with decreased gray-matter density (GMD) in Victims of Rape (VoR) with post-traumatic stress disorder (PTSD) compared to VoR without PTSD. Part D shows the areas with increased GMD.

L: left; R: right; MTG: middle temporal gyrus; IPL: inferior parietal lobule.

Fig. 3. Brain regions showing abnormalities in GMD in VoR with PTSD versus VoR without PTSD

Abnormal Brain Density in Victims of Rape with PTSD in Mainland

**4.3 The temporal gyrus** 

**4.4 The limbic lobe** 

PTSD.

**4.5 The cerebellum** 

China: A Voxel-Based Analysis of Magnetic Resonance Imaging Study 385

Our study showed significant GMD decreases in the left middle temporal gyrus in VoR with PTSD compared to HC. Studies comparing veterans with and without PTSD reveals that those with PTSD had overactivation of the temporal gyrus during the resting state (Molina et al., 2010) and the encoding phase (Geuze et al., 2008b), and underactivation of the bilateral middle temporal gyrus in the retrieval phase (Geuze et al., 2008b). Functional neuroimaging studies reveals significant activation in left middle temporal gyrus in response to empathy judgments in post-therapy PTSD (Farrow et al., 2005) and higher levels of activation in the middle temporal gyrus in dissociative PTSD (Lanius et al., 2006). Empirical evidence suggests that the fusiform cortex is specialized for face processing (Rossion et al., 2000; Rhodes et al., 2004). Research also indicates relatively augmented activity in the fusiform cortex in patients with PTSD (Bonne et al., 2003; Molina et al., 2010). The reduced GMD of the middle temporal gyrus and fusiform cortex found in this study implicates these regions in the dysfunction of memory and dissociative symptoms in PTSD.

In the present study, VoR with PTSD had significant increases in GMD in the right posterior cingulate cortex compared to HC. Meta-analyses have revealed that the prominent themes in the posterior cingulate cortex are episodic memory retrieval and pain (Nielsen et al., 2005), visuospatial processing and assessment of threat (Nemeroff et al., 2006), as well as fear conditioning (Doronbekov et al., 2005). Comparison of connectivity maps by functional connectivity analyses (Lanius et al., 2004) reveals that subjects with PTSD showed greater correlations in interregional brain activity than subjects without PTSD in the right posterior cingulate cortex (BA 29). Functional neuroimaging studies have found increased activation in the posterior cingulate cortex in victims with PTSD compared to victims without PTSD and to healthy controls (Bremner et al., 1999a, b, 2003; Doronbekov et al., 2005; Sachinvala et al., 2000). These indicate that dysfunction in the posterior cingulate cortex may underlie pathological symptoms provoked by traumatic reminders of sexual assault among VoR with

We found that the density of cerebellum, which plays an important role in motor and cognition (Mandolesi et al., 2001; Bischoff-Grethe et al., 2002; Vokaer et al., 2002; Claeys et al., 2003; Guenther et al., 2005; Allen et al., 2005; Konarski et al., 2005; Schmahmann & Caplan, 2006; Gianaros et al., 2007; Schweizer et al., 2007), was increased in patients with PTSD. Combination of early studies about structural abnormal (Leroi et al., 2002; Liszewski et al., 2004; Bellis & Kuchibhatla, 2006) and functional abnormal (Bonne et al., 2003; Molina et al., 2010; Gianaros et al., 2007; Liotti et al., 2000; Phan et al., 2002) in the cerebellum in PTSD patients, the finding is consistent with our hypothesis that the cerebellum was involved in the neuropathology of cognitive processing and emotional processing in PTSD patients. Furthermore, the density increased in the cerebellum while decreased in the prefrontal cortex. According to the anatomical studies that the cerebellum interacts with the prefrontal cortex via the thalamus (Middleton & Strick, 2001; Zhu et al., 2006), and the functional studies that the cerebellum influences several areas of the prefrontal cortex via the thalamus (Middleton & Strick, 2001) and exhibits a pattern similar to the frontal cortex during semantic decisions (Gold & Buckner, 2002), the findings suggest that the cerebellum

Figure 2, and include the left pre-central cortex (E-1), the left inferior parietal lobule (E-2), and the right post-central cortex (E-3). The MNI coordinates, voxel t values, k values (cluster size > 50), and corresponding BA are detailed in Table 3. Regions displayed are for p < .005.
