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Dynamic changes in white matter microstructure in anorexia nervosa: findings from a longitudinal study

Published online by Cambridge University Press:  28 August 2018

Nina von Schwanenflug
Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany Neurology Department, Charité-Universitätsmedizin Berlin, Berlin, Germany
Dirk K. Müller
Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
Joseph A. King
Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
Franziska Ritschel
Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
Fabio Bernardoni
Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
Siawoosh Mohammadi
Department of Systems Neuroscience, Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
Daniel Geisler
Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
Veit Roessner
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Eating Disorder Research and Treatment Center, Technische Universität Dresden, Dresden, Germany
Ronald Biemann
Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University, Magdeburg, Germany
Michael Marxen
Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
Stefan Ehrlich*
Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany Department of Child and Adolescent Psychiatry, Faculty of Medicine, Eating Disorder Research and Treatment Center, Technische Universität Dresden, Dresden, Germany
Author for correspondence: Stefan Ehrlich, E-mail:



Gray matter (GM) ‘pseudoatrophy’ is well-documented in patients with anorexia nervosa (AN), but changes in white matter (WM) are less well understood. Here we investigated the dynamics of microstructural WM brain changes in AN patients during short-term weight restoration in a combined longitudinal and cross-sectional study design.


Diffusion-weighted images were acquired in young AN patients before (acAN-Tp1, n = 56) and after (acAN-Tp2, n = 44) short-term weight restoration as well as in age-matched healthy controls (HC, n = 60). Images were processed using Tract-Based-Spatial-Statistics to compare fractional anisotropy (FA) across groups and timepoints.


In the cross-sectional comparison, FA was significantly reduced in the callosal body in acAN-Tp1 compared with HC, while no differences were found between acAN-Tp2 and HC. In the longitudinal arm, FA increased with weight gain in acAN-Tp2 relative to acAN-Tp1 in large parts of the callosal body and the fornix, while it decreased in the right corticospinal tract.


Our findings reveal that dynamic, bidirectional changes in WM microstructure in young underweight patients with AN can be reversed with brief weight restoration therapy. These results parallel those previously observed in GM and suggest that alterations in WM in non-chronic AN are also state-dependent and rapidly reversible with successful intervention.

Original Articles
Copyright © Cambridge University Press 2018 

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These authors shared first authorship.


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