将成像生物标志物应用于精神病学的临床实践。

IF 22.5 1区 医学 Q1 PSYCHIATRY
Amit Etkin, Daniel H Mathalon
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引用次数: 0

摘要

重要性:推进精准精神病学,即根据个体的生物学特征而非单纯的临床表现进行治疗,需要关注任何候选生物标记物的几个关键属性。其中包括测试重复可靠性、对相关神经生理学的敏感性、成本效益和可扩展性。遗憾的是,使用磁共振成像(MRI)和脑电图(EEG)等常见神经成像工具的生物标记物开发工作尚未系统地解决这些问题。在此,我们将探讨神经成像方法需要克服的关键障碍,以便在近期到中期内实现临床相关性:可靠性经常被忽视,再加上对神经生理学关键方面的敏感性和可重复的预测效用,基于脑电图的方法更受青睐。脑电图的主要障碍是缺乏多地点精神病学联盟的大规模数据收集。相比之下,尽管结构磁共振成像具有很高的可靠性,但它在精神病学中并未显示出临床实用性,这可能是由于它对精神病学相关神经生理学的敏感性有限。鉴于结构磁共振成像的普遍性,建立一个令人信服的临床用例仍然是其主要障碍。相比之下,可靠性低和难以标准化采集是功能磁共振成像的主要障碍,同时还需要证明其优于脑电图的空间分辨率和直接成像皮层下区域的能力确实具有独特的临床价值。此外,如何平衡这些科学问题与当今精神科医疗保健服务的实际经济现实之间的关系往往是一个缺失,为此,在生物标记物开发工作中嵌入经济建模可能有助于指导研究工作:特别是考虑到脑电图的可扩展性和成本效益,脑电图对近期和中期临床影响的时机似乎最为成熟。最近为扩大其收集范围所做的努力以及低成本交钥匙系统的开发,都表明神经成像技术是影响临床治疗的一条大有可为的途径。针对其关键障碍继续开展核磁共振成像研究可能会带来更长远的应用前景。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bringing Imaging Biomarkers Into Clinical Reality in Psychiatry.

Importance: Advancing precision psychiatry, where treatments are based on an individual's biology rather than solely their clinical presentation, requires attention to several key attributes for any candidate biomarker. These include test-retest reliability, sensitivity to relevant neurophysiology, cost-effectiveness, and scalability. Unfortunately, these issues have not been systematically addressed by biomarker development efforts that use common neuroimaging tools like magnetic resonance imaging (MRI) and electroencephalography (EEG). Here, the critical barriers that neuroimaging methods will need to overcome to achieve clinical relevance in the near to intermediate term are examined.

Observations: Reliability is often overlooked, which together with sensitivity to key aspects of neurophysiology and replicated predictive utility, favors EEG-based methods. The principal barrier for EEG has been the lack of large-scale data collection among multisite psychiatric consortia. By contrast, despite its high reliability, structural MRI has not demonstrated clinical utility in psychiatry, which may be due to its limited sensitivity to psychiatry-relevant neurophysiology. Given the prevalence of structural MRIs, establishment of a compelling clinical use case remains its principal barrier. By contrast, low reliability and difficulty in standardizing collection are the principal barriers for functional MRI, along with the need for demonstration that its superior spatial resolution over EEG and ability to directly image subcortical regions in fact provide unique clinical value. Often missing, moreover, is consideration of how these various scientific issues can be balanced against practical economic realities of psychiatric health care delivery today, for which embedding economic modeling into biomarker development efforts may help direct research efforts.

Conclusions and relevance: EEG seems most ripe for near- to intermediate-term clinical impact, especially considering its scalability and cost-effectiveness. Recent efforts to broaden its collection, as well as development of low-cost turnkey systems, suggest a promising pathway by which neuroimaging can impact clinical care. Continued MRI research focused on its key barriers may hold promise for longer-horizon utility.

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来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
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