Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Transl Psychiatry. 2022 Jun 14;12(1):248. doi: 10.1038/s41398-022-01990-2.
Mental disorders represent an increasing source of disability and high costs for societies globally. Molecular imaging techniques such as positron emission tomography (PET) represent powerful tools with the potential to advance knowledge regarding disease mechanisms, allowing the development of new treatment approaches. Thus far, most PET research on pathophysiology in psychiatric disorders has focused on the monoaminergic neurotransmission systems, and although a series of discoveries have been made, the results have not led to any material changes in clinical practice. We outline areas of methodological development that can address some of the important obstacles to fruitful progress. First, we point towards new radioligands and targets that can lead to the identification of processes upstream, or parallel to disturbances in monoaminergic systems. Second, we describe the development of new methods of PET data quantification and PET systems that may facilitate research in psychiatric populations. Third, we review the application of multimodal imaging that can link molecular imaging data to other aspects of brain function, thus deepening our understanding of disease processes. Fourth, we highlight the need to develop imaging study protocols to include longitudinal and interventional paradigms, as well as frameworks to assess dimensional symptoms such that the field can move beyond cross-sectional studies within current diagnostic boundaries. Particular effort should be paid to include also the most severely ill patients. Finally, we discuss the importance of harmonizing data collection and promoting data sharing to reach the desired sample sizes needed to fully capture the phenotype of psychiatric conditions.
精神障碍是全球范围内导致残疾和社会高成本的主要原因之一。分子影像学技术，如正电子发射断层扫描（PET），是一种强大的工具，具有深入了解疾病机制的潜力，从而为开发新的治疗方法提供可能。到目前为止，大多数关于精神疾病病理生理学的 PET 研究都集中在单胺能神经传递系统上，虽然已经取得了一系列发现，但这些结果并没有导致临床实践的任何实质性改变。我们概述了一些可以解决一些重要障碍的方法学发展领域，以促进富有成效的进展。首先，我们指出了一些新的放射性配体和靶点，它们可以识别单胺能系统紊乱之前或与之平行的过程。其次，我们描述了新的 PET 数据定量和 PET 系统的开发方法，这可能有助于对精神科人群进行研究。第三，我们回顾了多模态成像的应用，它可以将分子影像学数据与大脑功能的其他方面联系起来，从而深入了解疾病过程。第四，我们强调了需要开发成像研究方案，包括纵向和介入性范式，以及评估维度症状的框架，以使该领域能够超越当前诊断范围内的横断面研究。特别需要努力纳入病情最严重的患者。最后，我们讨论了协调数据收集和促进数据共享的重要性，以达到充分捕捉精神疾病表型所需的理想样本量。
