Two-week rTMS-induced neuroimaging changes measured with fMRI in depression

•We first combined the amplitude of low frequency fluctuation (ALFF) and functional connection degree (FCD) as rest-state fMRI indicators to explore the neuroimaging mechanisms of rTMS in patients with major depressive disorder (MDD).•Our study focused not only on the whole brain but also on the three brain networks (default mode network [DMN], central executive network [CEN], salience network [SN]).•The rTMS resulted in changes in the regional function of the left dorsolateral prefrontal lobe and CEN.•The rTMS might affect other brain networks through interactions between the CEN and other large-scale networks. To study the neuroimaging mechanisms of repetitive transcranial magnetic stimulation (rTMS) in treating major depressive disorder (MDD). Twenty-seven treatment-naive patients with major depressive disorder (MDD) and 27 controls were enrolled. All of them were scanned with resting-state functional magnetic resonance imaging (fMRI) at baseline, and 15 patients were rescanned after two-week rTMS. The amplitude of low frequency fluctuation (ALFF) and functional connection degree (FCD), based on voxels and 3 brain networks (default mode network [DMN], central executive network [CEN], salience network[SN]),were used as imaging indicators to analyze. The correlations of brain imaging changes after rTMS with clinical efficacy were calculated. At baseline, patients groups showed increased ALFF in the right orbital frontal cortex (OFC) and decreased ALFF in the left striatal cortex and medial prefrontal cortex (PFC), while increased FCD in the right dorsal anterior cingulate cortex and OFC and decreased FCD in the right inferior parietal lobe and in the CEN. After rTMS, patients showed increased ALFF in the left dorsolateral prefrontal cortex (DLPFC)and superior frontal gyrus, FCD in the right dorsal anterior cingulate cortex, superior temporal gyrus and CEN, as well as decreased FCD in the bilateral lingual gyrus than pre-rTMS . These rTMS induced neuroimaging changes did not significantly correlated with clinical effecacy. This study indicated that rTMS resulted in changes of ALFF and FCD in some brain regions and CEN. But we could not conclude this is the neuroimaging mechanism of rTMS according to the correlation analysis.