Schedule of Events | Symposia

Prevalence and clinical significance of incidental findings in pre-treatment MRI for rTMS in treatment-resistant MDD

Poster Session E - Monday, March 31, 2025, 2:30 – 4:30 pm EDT, Back Bay Ballroom/Republic Ballroom

Claire A Ho¹ (cah4022@med.cornell.edu), Jeremy Levit², Nicola Manfredi¹, Megan E Chang¹, Indira L Summerville¹, Jolin Chou¹, Megan Johnson¹, Hayley Seltzberg¹, Lindsay W Victoria¹, Charles J Lynch¹, Immanuel G Elbau¹, Conor Liston¹, Benjamin Zebley¹; ¹Weill Cornell Medicine, ²NewYork-Presbyterian Hospital

The use of MRI screening before repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) is a topic of debate. MRI can identify pathologies that contribute to depressive symptoms or increase seizure risk but is costly and of uncertain utility. This is partially due to previous reports of no significant differences in incidental findings (IFs) between psychiatric and healthy populations, with clinically significant IF rates of 0.9% (Russel et al., 2024). We report preliminary findings from two ongoing randomized trials evaluating TMS for treatment-resistant MDD, which used structural MRI for neuronavigation. Analysis of 179 scans by neuroradiologists identified 60 IFs (33.5%) in total. Most prevalent were white matter hyperintensities (8.9%), parenchymal volume loss (3.9%), and pituitary/sellar lesions (2.8%). Sixteen IF (8.9%) were clinically significant and warranted clinical follow-up, exceeding reported rates. Six (3.4%) presented serious safety concerns warranting study exclusion due to elevated seizure risk, all lesions with mass effect. These findings suggest the rate of relevant MRI findings may be higher than previously assumed in psychiatric populations. Pre-TMS MRI serves two key purposes: identifying seizure risk factors, such as lesions, cerebrovascular abnormalities, or traumatic brain injury sequelae, and detecting brain-structural causes of depression, such as autoimmune-mediated lesions or prefrontal and pituitary tumors. The higher-than-reported prevalence of risk-bearing findings in our sample may reflect characteristics of treatment-resistant populations, suggesting these abnormalities are more common in this group. If confirmed, these results support the use of pre-treatment MRI for TMS in both clinical and research settings.

Topic Area: NEUROANATOMY