BACKGROUND Conduct disorder is associated with the highest burden of any mental disorder in childhood, yet its neurobiology remains unclear. Inconsistent findings limit our understanding of the role of brain structure alterations in conduct disorder. This study aims to identify the most robust and replicable brain structural correlates of conduct disorder. METHODS The ENIGMA-Antisocial Behavior Working Group performed a coordinated analysis of structural MRI data from 15 international cohorts. Eligibility criteria were a mean sample age of 18 years or less, with data available on sex, age, and diagnosis of conduct disorder, and at least ten participants with conduct disorder and ten typically developing participants. 3D T1-weighted MRI brain scans of all participants were pre-processed using ENIGMA-standardised protocols. We assessed group differences in cortical thickness, surface area, and subcortical volumes using general linear models, adjusting for age, sex, and total intracranial volume. Group-by-sex and group-by-age interactions, and DSM-subtype comparisons (childhood-onset vs adolescent-onset, and low vs high levels of callous-unemotional traits) were investigated. People with lived experience of conduct disorder were not involved in this study. FINDINGS We collated individual participant data from 1185 young people with conduct disorder (339 [28·6%] female and 846 [71·4%] male) and 1253 typically developing young people (446 [35·6%] female and 807 [64·4%] male), with a mean age of 13·5 years (SD 3·0; range 7-21). Information on race and ethnicity was not available. Relative to typically developing young people, the conduct disorder group had lower surface area in 26 cortical regions and lower total surface area (Cohen's d 0·09-0·26). Cortical thickness differed in the caudal anterior cingulate cortex (d 0·16) and the banks of the superior temporal sulcus (d -0·13). The conduct disorder group also had smaller amygdala (d 0·13), nucleus accumbens (d 0·11), thalamus (d 0·14), and hippocampus (d 0·12) volumes. Most differences remained significant after adjusting for ADHD comorbidity or intelligence quotient. No group-by-sex or group-by-age interactions were detected. Few differences were found between DSM-defined conduct disorder subtypes. However, individuals with high callous-unemotional traits showed more widespread differences compared with controls than those with low callous-unemotional traits. INTERPRETATION Our findings provide robust evidence of subtle yet widespread brain structural alterations in conduct disorder across subtypes and sexes, mostly in surface area. These findings provide further evidence that brain alterations might contribute to conduct disorder. Greater consideration of this under-recognised disorder is needed in research and clinical practice. FUNDING Academy of Medical Sciences and Economic and Social Research Council.

中文翻译：

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品行障碍的皮质结构和皮质下体积：对来自 ENIGMA 反社会行为工作组的 15 个国际队列的协调分析。


背景品行障碍与儿童时期所有精神障碍的最高负担相关，但其神经生物学仍不清楚。不一致的研究结果限制了我们对大脑结构改变在品行障碍中的作用的理解。这项研究旨在确定行为障碍的最强大和可复制的大脑结构相关性。方法 ENIGMA-反社会行为工作组对来自 15 个国际队列的结构 MRI 数据进行了协调分析。资格标准是样本平均年龄为 18 岁或以下，提供有关性别、年龄和行为障碍诊断的数据，并且至少有 10 名患有行为障碍的参与者和 10 名正在发育的参与者。所有参与者的 3D T1 加权 MRI 脑部扫描均使用 ENIGMA 标准化协议进行预处理。我们使用一般线性模型评估了皮质厚度、表面积和皮质下体积的组间差异，并根据年龄、性别和颅内容积进行了调整。研究了按性别和按年龄分组的相互作用，以及 DSM 亚型比较（儿童期发病与青少年发病，以及冷酷无情特征的低水平与高水平）。有行为障碍经历的人没有参与这项研究。研究结果 我们整理了 1185 名患有品行障碍的年轻人（339 [28·6%] 女性和 846 [71·4%] 男性）和 1253 名正常发育的年轻人（446 [35·6%] 女性和 807 [1] 名男性）的个人参与者数据。 64·4%] 男性），平均年龄 13·5 岁（SD 3·0；范围 7-21）。无法获得有关种族和民族的信息。相对于正常发育的年轻人，行为障碍组的 26 个皮质区域的表面积较低，总表面积也较低（Cohen's d 0·09-0·26）。 尾侧前扣带皮层 (d 0·16) 和颞上沟岸 (d -0·13) 的皮质厚度不同。品行障碍组的杏仁核（d 0·13）、伏核（d 0·11）、丘脑（d 0·14）和海马（d 0·12）体积也较小。在调整多动症合并症或智商后，大多数差异仍然显着。没有检测到按性别或按年龄分组的相互作用。 DSM 定义的品行障碍亚型之间几乎没有发现差异。然而，与对照组相比，具有高冷酷无情感特征的个体比具有低冷酷无情感特征的个体表现出更广泛的差异。解释我们的研究结果提供了强有力的证据，证明行为障碍在不同亚型和性别中存在微妙但广泛的大脑结构改变，主要是在表面区域。这些发现进一步证明大脑改变可能导致品行障碍。在研究和临床实践中需要更多地考虑这种未被充分认识的疾病。资助医学科学院和经济与社会研究理事会。