Psychoradiology: The Frontier of Neuroimaging in Psychiatry

Abstract

Unlike neurologic conditions, such as brain tumors, dementia, and stroke, the neural mechanisms for all psychiatric disorders remain unclear. A large body of research obtained with structural and functional magnetic resonance imaging, positron emission tomography/single photon emission computed tomography, and optical imaging has demonstrated regional and illness-specific brain changes at the onset of psychiatric disorders and in individuals at risk for such disorders. Many studies have shown that psychiatric medications induce specific measurable changes in brain anatomy and function that are related to clinical outcomes. As a result, a new field of radiology, termed psychoradiology, seems primed to play a major clinical role in guiding diagnostic and treatment planning decisions in patients with psychiatric disorders. This article will present the state of the art in this area, as well as perspectives regarding preparations in the field of radiology for its evolution. Furthermore, this article will (a) give an overview of the imaging and analysis methods for psychoradiology; (b) review the most robust and important radiologic findings and their potential clinical value from studies of major psychiatric disorders, such as depression and schizophrenia; and (c) describe the main challenges and future directions in this field. An ongoing and iterative process of developing biologically based nomenclatures with which to delineate psychiatric disorders and translational research to predict and track response to different therapeutic drugs is laying the foundation for a shift in diagnostic practice in psychiatry from a psychologic symptom-based approach to an imaging-based approach over the next generation. This shift will require considerable innovations for the acquisition, analysis, and interpretation of brain images, all of which will undoubtedly require the active involvement of radiologists.q RSNA, 2016 Online supplemental material is available for this article.This copy is for personal use only. To order printed copies, contact reprints@rsna.org STATE OF THE ART: PsychoradiologyLui et al imaging study of schizophrenia with CT revealed bilaterally enlarged ventricles, which was an important con firmation of the neuropathology of the disorder (1). Since then, many psychiatry researchers have used brain imaging to elucidate the profile of brain abnormalities associated with different psychiatric disorders. This effort accelerated considerably in recent years because of the rapid and extensive growth and development in MR imaging, molecular imaging, and other diagnostic imaging techniques.Increased understanding of neurobiologic mechanisms of psychiatric disorders, increased technical capacities of human brain imaging, and many compelling demonstrations of differences between patients and control subjects in terms of brain anatomy and function provide the basis for the emergence of the clinical subspecialty of psychoradiology. Although clinical application of psychoradiology is not on the immediate horizon, th...

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Anomalous single‐subject based morphological cortical networks in drug‐naive, first‐episode major depressive disorder

“…proposed the Psychoradiology, a new field of radiology, which seems primed to play a major clinical role in guiding diagnostic and treatment planning decisions in patients with psychiatric disorders [Lui et al, 2016]. Psychoradiological studies of depressed patients have demonstrated focal functional and structural alterations in cortical and subcortical regions, including dorsolateral prefrontal cortex [Fitzgerald et al, 2006;Groenewold et al, 2013;Hamilton et al, 2012;Wise et al, 2016], anterior cingulate cortex (ACC) [Drevets et al, 1998;Groenewold et al, 2013;Pizzagalli, 2011;Schmaal et al, 2016a], posterior cingulate cortex/precuneus (PCC/PCu) [Mah et al, 2007], amygdala [Groenewold et al, 2013;Hamilton et al, 2012;Mah et al, 2007], hippocampus Lui et al, 2009;Schmaal et al, 2016b;Wise et al, 2016] and caudate nucleus [Krishnan et al, 1992;Pizzagalli et al, 2009;Schmaal et al, 2016b].…”