British Medical Bulletin 65:1-2 (2003)
© 2003 The British Council
Introduction
In this volume, 'imaging neuroscience' refers to the use of the non-invasive imaging modalities to investigate the structure and function of the human brain in health and disease. The development of new imaging modalities in the last 25 years has been astonishing. The neuroscientist, neurologist, and psychiatrist can now visualise multiple levels of brain organisation through ultra-microscopes of various types right through to the tools of modern neuroradiology, the MRI, CT and PET scanners. The subject matter of this volume is what these latter modalities are contributing to clinical knowledge in terms of the understanding of pathogenic mechanisms and in the description of disease progression. In turn, this knowledge is beginning to suggest ways of translating discoveries made in the laboratory into the clinic for identification of new therapeutic targets, development of new non-invasive diagnostic tests and the evaluation of new treatments.
The articles seek to review the state of the art across a range of clinical scientific topics that have been examined with scanners. The approach is not scanner-centred but topic-centred, and the hope we have is that the information conveyed will help clinicians and clinical scientists who are looking for new information of practical value. Nevertheless, the volume starts with an introduction to the methods, but it is written in a way that should be approachable by those who are interested.
Functional imaging is contributing much new information to studies of higher function, perception, action and emotion. Results in normal people are leading to new ideas about schizophrenia, depression and other psychiatric disorders. The degenerative disorders leading to difficulties with memory, language and action are also coming under an increasing range of imaging studies. There have been major advances in recent years starting in structural imaging with computerised, statistical, voxel-based data analysis that makes the visualisation of wide-spread degeneration easier and more objective, through to analyses of functional brain systems in terms of their components and their interactions. There is now a strong case to be made that the field has reached a maturity that allows us to consider quantitative imaging features as surrogate indices of disease progression. This advance opens the door to improved efficiency in the design of therapeutic trials and to proof-of-principle, pharmacokinetic, dose-ranging and drug-distribution studies. Indeed, we now have in our hands a whole new range of possibilities for the prosecution of translational research in neurology and psychiatry.
The application of imaging to therapeutic issues can only proceed with a better understanding of pathogenic mechanisms and then identification of new therapeutic targets. This volume, therefore, closes with a description of some of the more intriguing recent applications of imaging. Imaging genomics refers to visualising the expression of genes in tissues of the brain in animals that have been genetically modified to mimic the diseases that they are constructed to model. Indeed, imaging animal models in various ways, with greater resolution and sensitivity, is occupying many of the methodologists in the field. A sense of the progress made can be gained from these final chapters. In the future, it is to be expected that scaling up to humans will permit links to be made between genetic variability and structural or functional brain changes. The identification of the functional significance of proteins coded by disease associated genetic defects may most readily be accessed by a combination of genetic association and appropriate imaging studies.
Those interested in headache, dementia, multiple sclerosis, movement disorders, depression, pain syndromes and schizophrenia to name a few more general clinical problems will find much new information in this volume. We hope that it will serve to stimulate interest and to demystify the functional imaging techniques that have for some time seemed fascinating, without their clinical usefulness becoming apparent. Functional imaging will not have the impact on individual diagnostics that structural imaging has had with its ability to identify efficiently the nature and site of focal brain lesions. (Though, development of a practical capability to image intracerebral neuro-inflammation or amyloid could result in diagnostic information for individuals and molecular imaging might conceivably be helpful in the diagnosis of subtypes of psychosis, depression and addiction.)
The roles of functional imaging are to understand disease processes and symptom generation and to monitor disease progression in those diseases that result in slow or subtle changes in symptoms that appear late, when tissue loss is already profound. Functional imaging with activation is uniquely placed to elucidate diseases caused by abnormal changes in connectivity between brain areas. Such information requires data from group studies. Group studies define general abnormalities and provide data about the variability of any particular disease or state-related change. Functional imaging of individuals is of course possible. Individual studies allow the identification of any discrepancies from the group norm, be it in a normal or diseased population, at one point in time or over a defined time-span.
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- Driver J, Frackowiak RSJ. Imaging Selective Attention in the Human Brain. Oxford: Elsevier Science, 2001; 1255–371
- Frackowiak RSJ, Friston KJ, Frith CD, Dolan RJ, Mazziotta JC. Human Brain Function. San Diego, CA: Academic Press, 1997; 1–521
- Mazziotta JC, Toga A, Frackowiak RSJ. Brain Mapping: The Disorders. San Diego, CA: Academic Press, 2000; 1–669
- Phelps ME. Inaugural article: positron emission tomography provides molecular imaging of biological processes. Proc Natl Acad Sci USA 2000; 97: 9226–33
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