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Structural and Functional Imaging

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Psychiatric Disorders Late in Life

Abstract

The use of imaging studies in the clinical practice of psychiatry continues to lag behind the other clinical neurosciences. This explains the clinical psychiatrist’s relative unease with ordering and interpreting imaging studies. Even though various clinical practice guidelines in psychiatry recommend imaging studies as part of the diagnostic work-up for the psychiatric disorders, no signature imaging findings have been reported as diagnostic of any psychiatric disorder. This includes psychiatric disorders with onset later in life with the exception of the neurocognitive disorders. Over a decade of research in the role of diagnostic and prognostic biomarkers including imaging biomarkers in the neurocognitive disorders led to the framework first proposed by the International Working Group (IWG) in 2007 for diagnosing Alzheimer’s disease (AD) in which diagnostic biomarkers had a central role. This was subsequently expanded upon by the National Institute on Aging-Alzheimer’s Association (NIA-AA) criteria published in 2011. Around the same time, molecular imaging was approved for use in diagnosing some movement disorders. Consequently, imaging (and fluid) biomarkers have gradually found their way into memory and movement disorders clinics, and biomarkers now play an important role in categorizing several neurocognitive disorders as “possible” or “probable” as per the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) classification. This chapter provides a broad overview of the imaging modalities commonly used in the clinical practice of neuropsychiatry today that have documented diagnostic utility at the individual level. Indications for the use of imaging in the clinic are discussed first and a case is made for improving the training of psychiatrists in ordering and interpreting imaging studies. Next, structural, functional, and molecular imaging modalities are discussed in some detail, including computerized tomography (CT), magnetic resonance imaging (MRI), single photon emission computerized tomography (SPECT), positron emission tomography (PET), and dopamine transporter SPECT. Imaging modalities that are primarily used in research have not been covered unless the imaging modality is either a major breakthrough (functional MRI) or when it is expected that clinical use for that modality will be approved in the near future (amyloid PET, 123I-metaiodobenzylguanidine, MIBG myocardial scintigraphy). Practical aspects of archiving and viewing imaging studies are discussed at the end. Given that the clinical indications for the use of imaging studies in neuropsychiatry are still mostly restricted to the neurocognitive and movement disorders, the bulk of the chapter deals with the role of imaging studies in diagnosing these disorders. The role of imaging as a prognostic biomarker is outside the scope of this chapter. Also, the discussion in each section has been mostly limited to the underlying theory and general methodology, while the signature imaging findings in the individual disorders will be covered in the chapters on those disorders.

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Acknowledgments

The author gratefully acknowledges the contribution of Dr. David Pettersson, Assistant Professor in Neuroradiology, and Dr. Lisa Silbert, Associate Professor in Neurology and Director of the Neuroimaging Lab at the Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland, Oregon, who reviewed the final draft of this chapter and provided valuable feedback.

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  1. Department of Neurology, Oregon Health and Science University, Portland, OR, USA

    Vimal M. Aga M D, F.A.P.A.

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Correspondence to Vimal M. Aga M D, F.A.P.A. .

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Editors and Affiliations

  1. Professor of Psychiatry, Case Western Reserve University School of Medicine, Vice Chairman for Education and Faculty Development, Residency Program Director and Chief of Geriatric Psychiatry, MetroHealth, Cleveland, Ohio, USA

    Rajesh R. Tampi

  2. Executive Vice President, Clinical Services, Diamond Healthcare, Richmond, Virginia, USA

    Deena J. Tampi

  3. Associate Clinical Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health Program Director, Geriatric Psychiatry Fellowship, Madison, Wisconsin, USA

    Lisa L. Boyle

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Aga, V.M. (2018). Structural and Functional Imaging. In: Tampi, R., Tampi, D., Boyle, L. (eds) Psychiatric Disorders Late in Life. Springer, Cham. https://doi.org/10.1007/978-3-319-73078-3_15

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