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Elizabeth H. Aylward, PhD; Gordon J. Harris, PhD; Rudolf Hoehn-Saric, MD; Patrick E. Barta, MD, PhD; Steven R. Machlin, MD; Godfrey D. Pearlson, MB, BS

Arch Gen Psychiatry. 1996;53(7):577-584.

Abstract
Background
Prior neuroimaging studies have not consistently demonstrated a structural or functional abnormality of the caudate nucleus in patients with obsessivecompulsive disorder (OCD). However, there is theoretical support for some associated dysfunction of the caudate nucleus.

Methods
We examined volumes of the caudate nucleus and putamen with magnetic resonance imaging in 24 patients with adult-onset OCD and 21 control subjects, group-matched on age, race, education, and sex. Patients were relatively free from tics. To evaluate function (metabolism or blood flow) of the caudate nucleus, we performed a quantitative review, including a meta-analysis, of normalized data from functional neuroimaging studies that compared patients who had OCD with normal control subjects.

Results
All structural basal ganglia measures failed to exhibit differences between patients with OCD and matched normal control subjects. Patients did not demonstrate evidence of ventricular enlargement. Quantitative meta-analysis of the functional neuroimaging literature did not demonstrate a consistent abnormality of the caudate nucleus.

Conclusions
We did not observe evidence of a structural abnormality of the caudate nucleus in patients with OCD. Prior reports of a structural aberration of the caudate nucleus were mixed. We also did not find strong support for relative caudate metabolic or perfusion dysfunction in the literature, although increased function in the frontal cerebral cortex was identified. The heterogeneous nature of this disorder may account for inconsistencies between studies. For example, ventricular enlargement or reduced caudate volume or blood flow might be evident in patients with soft neurological signs (eg, tics), while patients in the current study were relatively free from tics. Although theories of OCD suggest a dysfunction of the caudate nucleus, the structural and functional neuroimaging literature has not consistently verified this.

Author Affiliations
From the Departments of Psychiatry and Behavioral Sciences (Drs Aylward, Hoehn-Saric, Barta, Machlin, and Pearlson) and Mental Hygiene (Dr Pearlson) and Division of Psychiatric Neuro-Imaging (Drs Aylward, Barta, and Pearlson), The Johns Hopkins University, Baltimore, Md, and the Neuroimaging Research Laboratory, Department of Psychiatry, Tufts University School of Medicine/New England Medical Center, Boston, Mass (Dr Harris).

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