The Role of Magnetic Resonance Imaging and Computed Tomography of the Brain in First Episode of Psychosis
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1 The Role of Magnetic Resonance Imaging and Computed Tomography of the Brain in First Episode of Psychosis Poster No.: C-0816 Congress: ECR 2012 Type: Authors: Scientific Exhibit N. Khandanpour 1, N. Hoggard 2, D. Connolly 2 ; 1 S10 2RA/UK, 2 Sheffield/UK Keywords: DOI: Acute, Diagnostic procedure, MR, CT, Management, Neuroradiology brain /ecr2012/C-0816 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9
2 Purpose The annual incidence of all psychoses in individuals aged over 15 years of age is approximately 0.3 per 1000.[1] There is a trend towards an increasing incidence of psychosis among some populations.[2,3] Structural abnormalities in the brain such as primary or secondary tumours, encephalitis or multiple sclerosis have been reported to be responsible for the first episode of psychosis (FEP).[4] Therefore, early identification of these lesions may benefit a group of these individuals as the lesions may be surgically or medically treatable. It is accepted that there is a need for establishing the best imaging policy for evaluation of individuals with FEP, however evidence about the role of magnetic resonance imaging (MRI) and / or computed tomography (CT) and their effect on management of these individuals is limited.[4,5 on page ] The aim of this study was to identify whether imaging is associated with early detection of organic causes for FEP? on page Methods and Materials Individuals with FEP but no neurological signs referred for cerebral magnetic resonance imaging (MRI) or computer tomography (CT) to a tertiary centre were reviewed retrospectively. Two groups were evaluated with either CT or MR scan, were independent and no individual had both CT and MRI scan. A group of healthy volunteers participated in research projects as normal controls were also imaged with MRI in the same centre[6] on page. The prevalence of positive findings between patients and the apparently healthy individuals were compared. [6] on page Hoggard N, Darwent G, Capener D, Wilkinson ID, Griffiths PD. The high incidence and bioethics of findings on magnetic resonance brain imaging of normal volunteers for neuroscience research. J Med Ethics Mar;35(3): Results Page 2 of 9
3 One hundred and twelve consecutive cerebral MR scans and 204 consecutive CT scans were identified. Three (2.7%) individuals had brain lesions (brain tumour and HIV encephalopathy) potentially accountable for the psychosis on MRI scan. Seventy patients (62.5%) had incidental brain lesions such as cerebral atrophy, small vessel ischaemic changes, unruptured Circle of Willis aneurysm, cavernoma and arachnoid cysts on MRI scan. Diagram 1 summarise the findings of MRI scan. There was no significant difference between MR and CT imaging in detecting organic pathology potentially responsible for FEP (P<0.001). Prevalence of cerebral small vessels ischaemic disease was significantly higher among individuals with FEP (45%) than an apparently healthy control group of volunteers from the same centre (3%) (p<0.0001) (Diagrams 3,4 and 5). Images for this section: Fig. 1: Diagram 1. MRI findings in individuals with first episode of psychosis* Others: Absence of the septum pellucidum (n=1), Basal ganglia calcification (n=1), Calvarial thickening due to underlying haematological condition (n=1), Arachnoid cyst (n=1), Page 3 of 9
4 Amyloid angiopathy (n=1), Mega cisterna magna (n=1). *Some individuals had more than one pathology Fig. 2: Diagram 2- CT scan findings in individuals with first episode of psychosis Page 4 of 9
5 Fig. 3: Diagram 3- Diagram illustrating the distribution of incidental findings by decade amongst the patients with first episode of psychosis on MRI scan Page 5 of 9
6 Fig. 4: Diagram 4- Diagram illustrating the distribution of incidental findings by decade amongst the patients with first episode of psychosis on CT scan. Page 6 of 9
7 Fig. 5: Diagram 5- Diagram illustrating the distribution of small vessel ischaemic changes by decade amongst apparently healthy individuals with MRI scan at the same centre (Hoggard N, et al J Med Ethics Mar;35(3):194-9).). Page 7 of 9
8 Conclusion 1. This study suggests that brain imaging, whatever the modality, is unlikely to reveal organic pathology in patients with FEP more frequently than in apparently healthy individuals. 2. This study also showed that that whatever the modality, it is unlikely to reveal organic pathology which would significantly affect management of the patient's FEP. 3. Moreover, CT scan revealed comparable pathology rates with MRI scan. 4. Selection of the patients with FEP on the basis of clinical suspicion for organic pathology rather than routine CT scan would prevent un-necessary radiation of patients. References 1 Baldwin P, Browne D, Scully PJ, Quinn JF, Morgan MG, Kinsella A, et al. Epidemiology of first episode psychosis: illustrating the challenges across diagnostic boundaries through the Cavan-Monaghan study at 8 years. Schizophr Bull 2005;31: Coid JW, Kirkbride JB, Barker D, Cowden F, Stamps R, Yang M, Jones PB. Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Arch Gen Psychiatry Nov;65(11): Bourque F, van der Ven E, Malla A. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med Jul 21: Albon E, Tsourapas A, Frew E, Davenport C, Oyebode F, Bayliss S, Arvanitis T, Meads C. Structural neuroimaging in psychosis. Systematic review and economic evaluation. Health Technology Assessment 2008; Vol. 12: No National Institute for Health and Clinical Excellence, Web site CG1, Updated 2008, Accesed 15/10/ Hoggard N, Darwent G, Capener D, Wilkinson ID, Griffiths PD. The high incidence and bioethics of findings on magnetic resonance brain imaging of normal volunteers for neuroscience research. J Med Ethics Mar;35(3): Page 8 of 9
9 Personal Information 1. Nader Khandanpour, MD, PhD, FRCR, Radiology Specialist Registrar, Academic unit of Radiology, C Floor, Royal Hallamshire Hospital, University of Sheffield, Sheffield, England Nkh950@yahoo.com 1. Nigel Hoggard, MRCP, MD, FRCR, Lead Researcher, Consultant Neuroradiologist, Academic unit of Radiology, C Floor, Royal Hallamshire Hospital, University of Sheffield, Sheffield, England n.hoggard@sheffield.ac.uk 1. Daniel J.A. Connolly, BSc, MRCP, FRCR, Head of School of Radiology, Consultant Neuroradiologist, Department of Radiology, Royal Hallamshire Hospital, Sheffield, England daniel.connolly@sth.nhs.uk Page 9 of 9
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