Structural network integrity of the central executive network is associated with the therapeutic effect of rTMS in treatment resistant depression.

Repetitive transcranial magnetic stimulation (rTMS) is a first-line option for treatment-resistant depression (TRD), but prediction of treatment outcome remains a clinical challenge. The present study aimed to compare structural and functional covariance networks (SCNs and FCNs) between remitters and nonremitters. We determined the predictive capacities of SCNs and FCNs to discriminate the two groups. Fifty TRD patients underwent a course of rTMS to the left dorsolateral prefrontal cortex. They were categorized into remitters (n = 22) and nonremitters (n = 28) based on HDRS≤7 at the end of treatment. Baseline structural and functional magnetic imaging (sMRI and fMRI) of the patients and 42 healthy controls were collected. SCNs and FCNs were defined based on structural and functional covariance of gray mater volume (GMV) and fractional amplitude of low-frequency fluctuations (fALFF) from sMRI and fMRI, respectively. Structural/functional network integrity of these networks (default mode network [DMN], central executive network [CEN] and salience network [SN]) were compared between the three groups. In patients, associations between SCNs and FCNs with clinical improvements were studied using linear correlation analysis. Receiver-operating characteristic (ROC) analysis was conducted to confirm the utility of the SCNs and FCNs in classifying clinical sub-groups. Nonremitters exhibited lower structural integrity in CEN than remitters and controls. Higher structural integrity of CEN was related to clinical improvement (r = 0.423, p = .002), and structural integrity distinguished remitters and nonremitters with a fairly high accuracy (AUC = 0.71, p = .008). No group differences or correlation with clinical changes were found in FCNs. Results suggest the CEN may play a role mediating clinical improvement in rTMS for depression. Structural covariance networks may be features to consider in prediction of clinical improvement.