Incidental radiological findings on brain magnetic resonance imaging in first‐episode psychosis and chronic schizophrenia

Abstract

Objective: To investigate whether patients with first‐episode psychosis or chronic schizophrenia have an increased incidence of magnetic resonance imaging (MRI) brain abnormalities compared with control subjects. Method: Totally 340 clinical MRI reports [Controls (n=98), first‐episode psychoses (n=152), chronic schizophrenia (n=90)] were reported by a neuroradiologist blind to diagnosis and subsequently categorized using referral criteria (immediate, urgent, routine or no referral). Results: Thirty percent of all scans were reported by a neuroradiologist as abnormal, but the majority required no referral. Patients with chronic schizophrenia were more likely to have clinically significant abnormal scans than patients with first episode psychosis or control subjects. In four patients the MRI findings led to the discovery of previously unsuspected pathology. Conclusion: Patients with chronic schizophrenia have an increased prevalence of incidental brain abnormalities. A small proportion of patients with chronic schizophrenia and first‐episode psychosis benefitted directly from MRI scanning.

Structural neuroimaging in psychosis: a systematic review and economic evaluation

“…86,88,[92][93][94]96,100,101,104,105,107 Five studies employed a retrospective review of medical records in conjunction with additional prospective data collection. 57,87,91,99,103 It was not always clear from the text whether studies were prospectively or retrospectively conducted.…”

“…None were diagnostic accuracy studies and so did not report sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratios or receiver operating characteristic curves. Some studies included one or more comparator groups 90,95,97,99,101,102,107 which took the form of a healthy control population or patients with another psychiatric diagnosis. The effectiveness of CT or MRI neuroimaging in healthy subjects or non-psychotic patients was not relevant to this review, so this information was not extracted.…”

“…88,92,97,102,103 Eighteen studies employed CT scanning for structural neuroimaging. 57,[85][86][87][88][89][91][92][93][94][95][96]100,103,104,[106][107][108] Four studies investigated MRI scans 90,97,99,105 and three studies used either CT or MRI to identify cerebral abnormalities in the patient population. 98,101,102 In all included studies (except for the review of case reports 108 ), it was intended that the patient population received either CT or MRI (or both).…”

“…Ten studies 57,87,90,94,96,98,99,[105][106][107] were designed to determine the prevalence of abnormal scan findings in a psychiatric population and appear to be cross-sectional in nature. The remaining studies sought to evaluate the use or impact of structural neuroimaging in various psychiatric populations 85,86,89,91,93,95,100,101,104 or to examine relationships between scan results and other clinical features.…”

First-Episode Psychosis: Emergency Assistance

“…No atendimento de emergência, deverá ser solicitada caso haja algum indício de comprometimento neurológico: início súbito (sem pródro-mo), alucinações visuais, rebaixamento do nível de consciên-cia, quadro infeccioso (quando houver suspeita de infecção do sistema nervoso central) ou psicoses de início tardio (acima dos 30 anos) [20][21][22][23][24] .…”