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NEUROLOGY 1997;48:589-601
© 1997 American Academy of Neurology

Volumetric MRI analysis comparing subjects having attention-deficit hyperactivity disorder with normal controls

P. A. Filipek, MD, M. Semrud-Clikeman, PhD, R. J. Steingard, MD, P. F. Renshaw, MD, PhD, D. N. Kennedy, PhD and J. Biederman, MD

From the Departments of Pediatrics and Neurology (Dr. Filipek), University of California College of Medicine, Irvine, Irvine, CA; Department of Neurology (Dr. Semrud-Clikeman), University of Minnesota College of Medicine, Minneapolis, MN; Department of Psychiatry (Dr. Steingard), Children's Hospital, Boston; Department of Psychiatry (Dr. Renshaw), McLean Hospital, Boston; and the Departments of Psychiatry (Dr. Biederman), Neurology and Radiology (Dr. Kennedy), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Supported in part by NS 24279 and NS 20489 (Dr. Filipek) from the National Institute of Neurological Disorders and Stroke; HD 27802 (Dr. Filipek) from the National Institute of Child Health and Human Development; a National Research Service Award, MH 14275 (Dr. Semrud-Clikeman), from the National Institutes of Mental Health, National Institutes of Health, Bethesda, MD; and the Massachusetts General Hospital Neuroscience Fellowship (Drs. Semrud-Clikeman and Renshaw).
Received December 26, 1995. Accepted in final form August 27, 1996.
Address correspondence and reprint requests to Dr. Pauline A. Filipek, Departments of Pediatrics and Neurology, 20T 4482, Building 27, University of California, Irvine, Medical Center, 101 City Drive South, Orange, CA 92868-3298.

Article abstract-Objective: To test by MRI-based morphometry the a priori hypotheses that developmental anomalies exist in attention-deficit hyperactivity disorder (ADHD) in left caudate and right prefrontal/frontal/ and/or posterior parietal hemispheric regions, in accord with neurochemical, neuronal circuitry and attentional network hypotheses, and prior imaging studies. Design: Case-control study. Setting: Academic medical center. Participants: Fifteen male subjects with ADHD without comorbid diagnoses (aged 12.4 +/- 3.4 years) and 15 male normal controls (aged 14.4 +/- 3.4), group-matched for age, IQ, and handedness. Main outcome measures: Global and hemispheric regional volumes (in cm3) of cerebral hemispheres, cortex, white matter, ventricles, caudate, lenticulate, central gray nuclei, insula, amygdala, and hippocampus. Results: Despite similar hemispheric volumes, ADHD subjects had smaller volumes of (1) left total caudate and caudate head (p < 0.04), with reversed asymmetry (p < 0.03); (2) right anterior-superior (frontal) region en bloc (p < 0.03) and white matter (p < 0.01); (3) bilateral anterior-inferior region en bloc (p < 0.04); and (4) bilateral retrocallosal (parietal-occipital) region white matter (p < 0.03). Possible structural correlates of ADHD response to stimulants were noted in an exploratory analysis, with the smallest and symmetric caudate, and smallest left anterior-superior cortex volumes found in the responders, but reversed caudate asymmetry and the smallest retrocallosal white matter volumes noted in the nonresponders. Conclusions: This study is the first to report localized hemispheric structural anomalies in ADHD, which are concordant with theoretical models of abnormal frontal-striatal and parietal function, and with possible differing morphologic substrates of response to stimulant medication.

NEUROLOGY 1997;48: 589-601




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