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Tseng CEJ, Canales C, Marcus RE, Parmar AJ, Hightower BG, Mullett JE, Makary MM, Tassone AU, Saro HK, Townsend PH, Birtwell K, Nowinski L, Thom RP, Palumbo ML, Keary C, Catana C, McDougle CJ, Hooker JM, Zürcher NR. In vivo translocator protein in females with autism spectrum disorder: a pilot study. Neuropsychopharmacology 2024; 49:1193-1201. [PMID: 38615126 PMCID: PMC11109261 DOI: 10.1038/s41386-024-01859-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
Sex-based differences in the prevalence of autism spectrum disorder (ASD) are well-documented, with a male-to-female ratio of approximately 4:1. The clinical presentation of the core symptoms of ASD can also vary between sexes. Previously, positron emission tomography (PET) studies have identified alterations in the in vivo levels of translocator protein (TSPO)-a mitochondrial protein-in primarily or only male adults with ASD, with our group reporting lower TSPO relative to whole brain mean in males with ASD. However, whether in vivo TSPO levels are altered in females with ASD, specifically, is unknown. This is the first pilot study to measure in vivo TSPO in the brain in adult females with ASD using [11C]PBR28 PET-magnetic resonance imaging (MRI). Twelve adult females with ASD and 10 age- and TSPO genotype-matched controls (CON) completed one or two [11C]PBR28 PET-MRI scans. Females with ASD exhibited elevated [11C]PBR28 standardized uptake value ratio (SUVR) in the midcingulate cortex and splenium of the corpus callosum compared to CON. No brain area showed lower [11C]PBR28 SUVR in females with ASD compared to CON. Test-retest over several months showed stable [11C]PBR28 SUVR across time in both groups. Elevated regional [11C]PBR28 SUVR in females with ASD stand in stark contrast to our previous findings of lower regional [11C]PBR28 SUVR in males with ASD. Preliminary evidence of regionally elevated mitochondrial protein TSPO relative to whole brain mean in ASD females may reflect neuroimmuno-metabolic alterations specific to females with ASD.
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Affiliation(s)
- Chieh-En Jane Tseng
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Camila Canales
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Rachel E Marcus
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Anjali J Parmar
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Baileigh G Hightower
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Jennifer E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Meena M Makary
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Cairo, Egypt
| | - Alison U Tassone
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Hannah K Saro
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Paige Hickey Townsend
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Kirstin Birtwell
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Lisa Nowinski
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Robyn P Thom
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Michelle L Palumbo
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Christopher Keary
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher J McDougle
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Jacob M Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Nicole R Zürcher
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA.
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Stogiannos N, Pavlopoulou G, Papadopoulos C, Walsh G, Potts B, Moqbel S, Gkaravella A, McNulty J, Simcock C, Gaigg S, Bowler D, Marais K, Cleaver K, Lloyd JH, Dos Reis CS, Malamateniou C. Strategies to improve the magnetic resonance imaging experience for autistic individuals: a cross-sectional study exploring parents and carers' experiences. BMC Health Serv Res 2023; 23:1375. [PMID: 38062422 PMCID: PMC10704820 DOI: 10.1186/s12913-023-10333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Autistic individuals encounter numerous barriers in accessing healthcare, including communication difficulties, sensory sensitivities, and a lack of appropriate adjustments. These issues are particularly acute during MRI scans, which involve confined spaces, loud noises, and the necessity to remain still. There remains no unified approach to preparing autistic individuals for MRI procedures. METHODS A cross-sectional online survey was conducted with parents and carers of autistic individuals in the UK to explore their experiences, barriers, and recommendations concerning MRI scans. The survey collected demographic information and experiential accounts of previous MRI procedures. Quantitative data were analysed descriptively, while key themes were identified within the qualitative data through inductive thematic analysis. RESULTS Sixteen parents/carers participated. The majority reported difficulties with communication, inadequate pre-scan preparation, and insufficient adjustments during MRI scans for their autistic children. Key barriers included an overwhelming sensory environment, radiographers' limited understanding of autism, and anxiety stemming from uncertainties about the procedure. Recommended improvements encompassed accessible communication, pre-visit familiarisation, noise-reduction and sensory adaptations, staff training on autism, and greater flexibility to meet individual needs. CONCLUSIONS There is an urgent need to enhance MRI experiences for autistic individuals. This can be achieved through improved staff knowledge, effective communication strategies, thorough pre-scan preparation, and tailored reasonable adjustments. Co-producing clear MRI guidelines with the autism community could standardise sensitive practices. An individualised approach is crucial for reducing anxiety and facilitating participation. Empowering radiographers through autism-specific education and incorporating insights from autistic individuals and their families could transform MRI experiences and outcomes.
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Affiliation(s)
- Nikolaos Stogiannos
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
- Medical Imaging Department, Corfu General Hospital, Corfu, Greece
| | - Georgia Pavlopoulou
- Department of Psychology and Human Development, University College London, Institute of Education Group for Research in Relationships in NeuroDiversity-GRRAND, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Chris Papadopoulos
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Campus, Luton, UK.
| | - Gemma Walsh
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Ben Potts
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
- Southampton General Hospital, University Hospitals Southampton Foundation Trust, Southampton, UK
| | - Sarah Moqbel
- Anna Freud National Centre for Children and Families, London, UK
| | | | - Jonathan McNulty
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Clare Simcock
- Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, London, UK
| | - Sebastian Gaigg
- Department of Psychology, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Dermot Bowler
- Department of Psychology, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Keith Marais
- Community Involvement, University of London, London, UK
| | - Karen Cleaver
- Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - Jane Harvey Lloyd
- Department of Specialist Science Education, University of Leeds, Leeds, UK
| | - Cláudia Sá Dos Reis
- School of Health Sciences (HESAV), University of Applied Sciences Western Switzerland (HES- SO), Lausanne, CH, Switzerland
| | - Christina Malamateniou
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
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Carlier S, Vorlet P, Sá Dos Reis C, Malamateniou C. Strategies, challenges and enabling factors when imaging autistic individuals in Swiss medical imaging departments. J Med Imaging Radiat Sci 2023; 54:S53-S63. [PMID: 36504166 DOI: 10.1016/j.jmir.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Autistic individuals may require medical imaging but they can face barriers that are related to lack of adjustments in their care. This study aims to explore and understand strategies currently used by Swiss radiographers to image autistic patients and to propose recommendations for clinical practice. METHODS The Swiss Ethics of the canton of Vaud committee approved the study. Data collection was gathered using a mixed method approach by an online survey and followed by selected interviews. Descriptive statistics and thematic analysis were used to analyse the data. RESULTS A hundred completed responses to the survey were obtained and five individual interviews were conducted. Sixty participants reported having managed autistic patients. The main enablers identified were: the support from carers, adapting the behaviour of staff and customising communication. The main challenges were a lack of communication and the lack of knowledge about autism to appropriately manage the patient. Only five radiographers had received prior training in autism. CONCLUSION Medical imaging departments must develop protocols to overcome the lack of communication between services, radiographers, and autistic service users. The lack of radiographer knowledge about autism can impact autistic patient management, resulting in carers playing an important role during the examination. Customised education for radiographers about autism is needed. IMPLICATION FOR PRACTICE The development of a scheduling protocol for each imaging modality could improve communication with the patient. The organisation of the physical environment and the patient's preparation for the examination are critical to provide adequate imaging care. It is suggested that medical imaging professionals, autistic service users, and autism organisations collaborate to develop autism related guidelines for medical imaging examinations.
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Affiliation(s)
- Sarah Carlier
- Etablissement Hospitaliers du Nord Vaudois, 1400 Yverdon-les-Bains, Switzerland.
| | - Patrick Vorlet
- French-Speaking Section of the Swiss Association of Radiographers (SVMTRA/ASTRM), Chemin de la Crosette 9, Lussery-Villars 1309, Switzerland; Cantonal University Hospital Vaud (CHUV), Bugnon 46, Lausanne 1011, Switzerland
| | - Cláudia Sá Dos Reis
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Av de Beaumont 21, Lausanne 1011, Switzerland
| | - Christina Malamateniou
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Av de Beaumont 21, Lausanne 1011, Switzerland; Division of Radiography & Midwifery, City, University of London, London, UK
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Thom RP, Canales C, Tresvalles M, McDougle CJ, Hooker JM, Chen Y, Zürcher NR. Neuroimaging research in Williams syndrome: Beginning to bridge the gap with clinical care. Neurosci Biobehav Rev 2023; 153:105364. [PMID: 37598875 DOI: 10.1016/j.neubiorev.2023.105364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/28/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
Williams syndrome (WS) is a genetic disorder affecting multiple organ systems. Cardinal features include cardiovascular disease, distinct facies, and a unique cognitive profile characterized by intellectual disability, hypersociability, and visuospatial weaknesses. Here, we synthesize neuroimaging research in WS with a focus on how the current literature and future work may be leveraged to improve health and quality of life in WS. More than 80 neuroimaging studies in WS have been conducted, the vast majority of which have focused on identifying morphometric brain differences. Aside from decreased volume of the parieto-occipital region and increased cerebellar volume, morphometric findings have been variable across studies. fMRI studies investigating the visuospatial deficit have identified dorsal stream dysfunction and abnormal activation of the hippocampal formation. Minimal work has been done using PET or MRS. Future approaches that conduct neuroimaging in tandem with clinical phenotyping, utilize novel imaging techniques to visualize brain vasculature or provide biochemical and molecular information, and include more homogenous age groups across the lifespan, have significant potential to advance clinical care.
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Affiliation(s)
- Robyn P Thom
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Camila Canales
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Mary Tresvalles
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA
| | - Christopher J McDougle
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Jacob M Hooker
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Yachin Chen
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Nicole R Zürcher
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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5
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The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:jcm12030843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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Molina-Maza JM, Galiana-Bordera A, Jimenez M, Malpica N, Torrado-Carvajal A. Development of a Super-Resolution Scheme for Pediatric Magnetic Resonance Brain Imaging Through Convolutional Neural Networks. Front Neurosci 2022; 16:830143. [DOI: 10.3389/fnins.2022.830143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric medical imaging represents a real challenge for physicians, as children who are patients often move during the examination, and it causes the appearance of different artifacts in the images. Thus, it is not possible to obtain good quality images for this target population limiting the possibility of evaluation and diagnosis in certain pathological conditions. Specifically, magnetic resonance imaging (MRI) is a technique that requires long acquisition times and, therefore, demands the use of sedation or general anesthesia to avoid the movement of the patient, which is really damaging in this specific population. Because ALARA (as low as reasonably achievable) principles should be considered for all imaging studies, one of the most important reasons for establishing novel MRI imaging protocols is to avoid the harmful effects of anesthesia/sedation. In this context, ground-breaking concepts and novel technologies, such as artificial intelligence, can help to find a solution to these challenges while helping in the search for underlying disease mechanisms. The use of new MRI protocols and new image acquisition and/or pre-processing techniques can aid in the development of neuroimaging studies for children evaluation, and their translation to pediatric populations. In this paper, a novel super-resolution method based on a convolutional neural network (CNN) in two and three dimensions to automatically increase the resolution of pediatric brain MRI acquired in a reduced time scheme is proposed. Low resolution images have been generated from an original high resolution dataset and used as the input of the CNN, while several scaling factors have been assessed separately. Apart from a healthy dataset, we also tested our model with pathological pediatric MRI, and it successfully recovers the original image quality in both visual and quantitative ways, even for available examples of dysplasia lesions. We hope then to establish the basis for developing an innovative free-sedation protocol in pediatric anatomical MRI acquisition.
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7
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Stogiannos N, Carlier S, Harvey-Lloyd JM, Brammer A, Nugent B, Cleaver K, McNulty JP, dos Reis CS, Malamateniou C. A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:782-797. [PMID: 34961364 PMCID: PMC9008560 DOI: 10.1177/13623613211065542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
LAY ABSTRACT Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.
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Affiliation(s)
| | - Sarah Carlier
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
- University of Lausanne, Switzerland
| | | | | | - Barbara Nugent
- City, University of London, UK
- MRI Safety Matters® Organisation, UK
- NHS National Education for Scotland, UK
| | | | | | - Cláudia Sá dos Reis
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
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De Picker LJ, Haarman BCM. Applicability, potential and limitations of TSPO PET imaging as a clinical immunopsychiatry biomarker. Eur J Nucl Med Mol Imaging 2021; 49:164-173. [PMID: 33735406 DOI: 10.1007/s00259-021-05308-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/08/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE TSPO PET imaging may hold promise as a single-step diagnostic work-up for clinical immunopsychiatry. This review paper on the clinical applicability of TSPO PET for primary psychiatric disorders discusses if and why TSPO PET imaging might become the first clinical immunopsychiatry biomarker and the investment prerequisites and scientific advancements needed to accommodate this transition from bench to bedside. METHODS We conducted a systematic search of the literature to identify clinical studies of TSPO PET imaging in patients with primary psychiatric disorders. We included both original case-control studies as well as longitudinal cohort studies of patients with a primary psychiatric diagnosis. RESULTS Thirty-one original studies met our inclusion criteria. In the field of immunopsychiatry, TSPO PET has until now mostly been studied in schizophrenia and related psychotic disorders, and to a lesser extent in mood disorders and neurodevelopmental disorders. Quantitative TSPO PET appears most promising as a predictive biomarker for the transdiagnostic identification of subgroups or disease stages that could benefit from immunological treatments, or as a prognostic biomarker forecasting patients' illness course. Current scanning protocols are still too unreliable, impractical and invasive for clinical use in symptomatic psychiatric patients. CONCLUSION TSPO PET imaging in its present form does not yet offer a sufficiently attractive cost-benefit ratio to become a clinical immunopsychiatry biomarker. Its translation to psychiatric clinical practice will depend on the prioritising of longitudinal research and the establishment of a uniform protocol rendering clinically meaningful TSPO uptake quantification at the shortest possible scan duration without arterial cannulation.
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Affiliation(s)
- Livia J De Picker
- University Psychiatric Hospital Campus Duffel, Stationsstraat 22C, 2570, Duffel, Belgium.
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Wilrijkstraat 1, 2650, Edegem, Belgium.
| | - Benno C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RA, Groningen, The Netherlands
- Rob Giel Research Center (RGOc), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RA, Groningen, The Netherlands
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Zürcher NR, Loggia ML, Mullett JE, Tseng C, Bhanot A, Richey L, Hightower BG, Wu C, Parmar AJ, Butterfield RI, Dubois JM, Chonde DB, Izquierdo-Garcia D, Wey HY, Catana C, Hadjikhani N, McDougle CJ, Hooker JM. [ 11C]PBR28 MR-PET imaging reveals lower regional brain expression of translocator protein (TSPO) in young adult males with autism spectrum disorder. Mol Psychiatry 2021; 26:1659-1669. [PMID: 32076115 PMCID: PMC8159742 DOI: 10.1038/s41380-020-0682-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/12/2020] [Accepted: 02/06/2020] [Indexed: 12/19/2022]
Abstract
Mechanisms of neuroimmune and mitochondrial dysfunction have been repeatedly implicated in autism spectrum disorder (ASD). To examine these mechanisms in ASD individuals, we measured the in vivo expression of the 18 kDa translocator protein (TSPO), an activated glial marker expressed on mitochondrial membranes. Participants underwent scanning on a simultaneous magnetic resonance-positron emission tomography (MR-PET) scanner with the second-generation TSPO radiotracer [11C]PBR28. By comparing TSPO in 15 young adult males with ASD with 18 age- and sex-matched controls, we showed that individuals with ASD exhibited lower regional TSPO expression in several brain regions, including the bilateral insular cortex, bilateral precuneus/posterior cingulate cortex, and bilateral temporal, angular, and supramarginal gyri, which have previously been implicated in autism in functional MR imaging studies. No brain region exhibited higher regional TSPO expression in the ASD group compared with the control group. A subset of participants underwent a second MR-PET scan after a median interscan interval of 3.6 months, and we determined that TSPO expression over this period of time was stable and replicable. Furthermore, voxelwise analysis confirmed lower regional TSPO expression in ASD at this later time point. Lower TSPO expression in ASD could reflect abnormalities in neuroimmune processes or mitochondrial dysfunction.
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Affiliation(s)
- N R Zürcher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - M L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - J E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - C Tseng
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Bhanot
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - L Richey
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - B G Hightower
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - C Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - A J Parmar
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - R I Butterfield
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - J M Dubois
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - D B Chonde
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - D Izquierdo-Garcia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - H Y Wey
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - C Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - N Hadjikhani
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gillberg Neuropsychiatry Center, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - C J McDougle
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - J M Hooker
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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10
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DeMayo MM, Pokorski I, Song YJC, Thapa R, Patel S, Ambarchi Z, Soligo D, Sadeli I, Thomas EE, Hickie IB, Guastella AJ. The Feasibility of Magnetic Resonance Imaging in a Non-Selective Comprehensive Clinical Trial in Pediatric Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:1211-1222. [PMID: 33903957 DOI: 10.1007/s10803-021-05028-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 12/16/2022]
Abstract
There is an increasing interest in using magnetic resonance imaging (MRI) as a tool for precision medicine in autism spectrum disorder (ASD). This study investigated the feasibility of MRI scanning in a large comprehensive, inclusive and test heavy clinical trial for children (aged 3-12 years) with ASD, without functioning constraints for participation. Of the 71 participants enrolled who consented to the MRI, 24 participants (38%) successfully completed an MRI scan at baseline along with other assessments. This scanning followed a familiarization procedure at two preceding visits. At post-treatment, 21 participants successfully completed the MRI scan. This study highlights the challenge of completing MRI assessments in ASD populations when conducted as one of a number of tests in a clinical trial.
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Affiliation(s)
- Marilena M DeMayo
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Izabella Pokorski
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Yun J C Song
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Rinku Thapa
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Shrujna Patel
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Zahava Ambarchi
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | | | - Indra Sadeli
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Emma E Thomas
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Ian B Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia.,Faculty of Medicine and Health, Brain and Mind Centre, Central Clinical School, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Adam J Guastella
- Faculty of Medicine and Health, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Autism Clinic for Translational Research, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia.
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11
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Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in autism research: literature review. Ir J Psychol Med 2021; 39:272-286. [PMID: 33818321 DOI: 10.1017/ipm.2021.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) remains a behaviourally defined condition. Its molecular basis is unknown; however, its prevalence has been increasing significantly. There have been several abnormalities in neurotransmitter systems reported in ASD. In our review, we described studies involving positron emission tomography (PET) and single-photon emission computed tomography (SPECT) that can provide useful and corroborative data. METHOD We conducted a literature review by comprehensive database searching on EMBASE, Scopus, PubMed, and PsychINFO looking for articles published since January 2009. Thirty-one studies were carefully selected - 22 PET studies and 9 SPECT studies - and reviewed by 2 independent researchers. References of the articles were also cross-checked. RESULTS Results of the studies, which mainly involve small groups of participants, are frequently inconclusive and often controversial due to the nature of ASD and its wide spectrum. Studies are conducted under different conditions and with poor control for confounding factors which creates difficulties in comparing the data. CONCLUSIONS There is ongoing need to improve methodology of the studies involving molecular imaging in ASD. Lack of consistent findings causes difficulties in evaluation, diagnosis, and treatment of the condition.
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12
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Kuschner ES, Kim M, Bloy L, Dipiero M, Edgar JC, Roberts TPL. MEG-PLAN: a clinical and technical protocol for obtaining magnetoencephalography data in minimally verbal or nonverbal children who have autism spectrum disorder. J Neurodev Disord 2021; 13:8. [PMID: 33485311 PMCID: PMC7827989 DOI: 10.1186/s11689-020-09350-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 12/10/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neuroimaging research on individuals who have autism spectrum disorder (ASD) has historically been limited primarily to those with age-appropriate cognitive and language performance. Children with limited abilities are frequently excluded from such neuroscience research given anticipated barriers like tolerating the loud sounds associated with magnetic resonance imaging and remaining still during data collection. To better understand brain function across the full range of ASD there is a need to (1) include individuals with limited cognitive and language performance in neuroimaging research (non-sedated, awake) and (2) improve data quality across the performance range. The purpose of this study was to develop, implement, and test the feasibility of a clinical/behavioral and technical protocol for obtaining magnetoencephalography (MEG) data. Participants were 38 children with ASD (8-12 years) meeting the study definition of minimally verbal/nonverbal language. MEG data were obtained during a passive pure-tone auditory task. RESULTS Based on stakeholder feedback, the MEG Protocol for Low-language/cognitive Ability Neuroimaging (MEG-PLAN) was developed, integrating clinical/behavioral and technical components to be implemented by an interdisciplinary team (clinicians, behavior specialists, scientists, and technologists). Using MEG-PLAN, a 74% success rate was achieved for acquiring MEG data, with a 71% success rate for evaluable and analyzable data. Exploratory analyses suggested nonverbal IQ and adaptive skills were related to reaching the point of acquirable data. No differences in group characteristics were observed between those with acquirable versus evaluable/analyzable data. Examination of data quality (evaluable trial count) was acceptable. Moreover, results were reproducible, with high intraclass correlation coefficients for pure-tone auditory latency. CONCLUSIONS Children who have ASD who are minimally verbal/nonverbal, and often have co-occurring cognitive impairments, can be effectively and comfortably supported to complete an electrophysiological exam that yields valid and reproducible results. MEG-PLAN is a protocol that can be disseminated and implemented across research teams and adapted across technologies and neurodevelopmental disorders to collect electrophysiology and neuroimaging data in previously understudied groups of individuals.
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Affiliation(s)
- Emily S Kuschner
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children's Hospital of Philadelphia, 2716 South Street, 5th Floor, Room 5251, Philadelphia, PA, 19146, USA. .,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Mina Kim
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children's Hospital of Philadelphia, 2716 South Street, 5th Floor, Room 5251, Philadelphia, PA, 19146, USA
| | - Luke Bloy
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children's Hospital of Philadelphia, 2716 South Street, 5th Floor, Room 5251, Philadelphia, PA, 19146, USA
| | - Marissa Dipiero
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children's Hospital of Philadelphia, 2716 South Street, 5th Floor, Room 5251, Philadelphia, PA, 19146, USA
| | - J Christopher Edgar
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children's Hospital of Philadelphia, 2716 South Street, 5th Floor, Room 5251, Philadelphia, PA, 19146, USA
| | - Timothy P L Roberts
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children's Hospital of Philadelphia, 2716 South Street, 5th Floor, Room 5251, Philadelphia, PA, 19146, USA
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13
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Zürcher NR, Walsh EC, Phillips RD, Cernasov PM, Tseng CEJ, Dharanikota A, Smith E, Li Z, Kinard JL, Bizzell JC, Greene RK, Dillon D, Pizzagalli DA, Izquierdo-Garcia D, Truong K, Lalush D, Hooker JM, Dichter GS. A simultaneous [ 11C]raclopride positron emission tomography and functional magnetic resonance imaging investigation of striatal dopamine binding in autism. Transl Psychiatry 2021; 11:33. [PMID: 33431841 PMCID: PMC7801430 DOI: 10.1038/s41398-020-01170-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023] Open
Abstract
The social motivation hypothesis of autism posits that autism spectrum disorder (ASD) is characterized by impaired motivation to seek out social experience early in life that interferes with the development of social functioning. This framework suggests that impaired mesolimbic dopamine function underlies compromised responses to social rewards in ASD. Although this hypothesis is supported by functional magnetic resonance imaging (fMRI) studies, no molecular imaging study has evaluated striatal dopamine functioning in response to rewards in ASD. Here, we examined striatal functioning during monetary incentive processing in ASD and controls using simultaneous positron emission tomography (PET) and fMRI. Using a bolus + infusion protocol with the D2/D3 dopamine receptor antagonist [11C]raclopride, voxel-wise binding potential (BPND) was compared between groups (controls = 12, ASD = 10) in the striatum. Striatal clusters showing significant between-group BPND differences were used as seeds in whole-brain fMRI general functional connectivity analyses. Relative to controls, the ASD group demonstrated decreased phasic dopamine release to incentives in the bilateral putamen and left caudate, as well as increased functional connectivity between a PET-derived right putamen seed and the precuneus and insula. Within the ASD group, decreased phasic dopamine release in the putamen was related to poorer theory-of-mind skills. Our findings that ASD is characterized by impaired striatal phasic dopamine release to incentives provide support for the social motivation hypothesis of autism. PET-fMRI may be a suitable tool to evaluate novel ASD therapeutics targeting the striatal dopamine system.
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Affiliation(s)
- Nicole R. Zürcher
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Erin C. Walsh
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA
| | - Rachel D. Phillips
- grid.10698.360000000122483208Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA
| | - Paul M. Cernasov
- grid.10698.360000000122483208Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA
| | - Chieh-En J. Tseng
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Ayarah Dharanikota
- grid.10698.360000000122483208Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC USA
| | - Eric Smith
- grid.10698.360000000122483208UNC-Chapel Hill Department of Radiology and Biomedical Research Imaging Center (BRIC), Chapel Hill, NC 27514 USA
| | - Zibo Li
- grid.10698.360000000122483208UNC-Chapel Hill Department of Radiology and Biomedical Research Imaging Center (BRIC), Chapel Hill, NC 27514 USA
| | - Jessica L. Kinard
- grid.10698.360000000122483208Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, NC 27510 USA
| | - Joshua C. Bizzell
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA
| | - Rachel K. Greene
- grid.10698.360000000122483208Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA
| | - Daniel Dillon
- grid.240206.20000 0000 8795 072XCenter for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA USA
| | - Diego A. Pizzagalli
- grid.240206.20000 0000 8795 072XCenter for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA USA
| | - David Izquierdo-Garcia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Kinh Truong
- grid.10698.360000000122483208Department of Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA
| | - David Lalush
- grid.10698.360000000122483208Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC USA
| | - Jacob M. Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Gabriel S. Dichter
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA ,grid.10698.360000000122483208Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514 USA ,grid.10698.360000000122483208Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, NC 27510 USA
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14
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Neumeyer AM, Thom RP, McDougle CJ. A rational pharmacologic approach toward a biologically meaningful subtype of autism spectrum disorder. J Pediatr (Rio J) 2021; 97:1-3. [PMID: 32473111 PMCID: PMC9432312 DOI: 10.1016/j.jped.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ann M Neumeyer
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Lexington, United States.
| | - Robyn P Thom
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, United States
| | - Christopher J McDougle
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Lexington, United States
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15
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Horien C, Fontenelle S, Joseph K, Powell N, Nutor C, Fortes D, Butler M, Powell K, Macris D, Lee K, Greene AS, McPartland JC, Volkmar FR, Scheinost D, Chawarska K, Constable RT. Low-motion fMRI data can be obtained in pediatric participants undergoing a 60-minute scan protocol. Sci Rep 2020; 10:21855. [PMID: 33318557 PMCID: PMC7736342 DOI: 10.1038/s41598-020-78885-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 01/21/2023] Open
Abstract
Performing functional magnetic resonance imaging (fMRI) scans of children can be a difficult task, as participants tend to move while being scanned. Head motion represents a significant confound in fMRI connectivity analyses. One approach to limit motion has been to use shorter MRI protocols, though this reduces the reliability of results. Hence, there is a need to implement methods to achieve high-quality, low-motion data while not sacrificing data quantity. Here we show that by using a mock scan protocol prior to a scan, in conjunction with other in-scan steps (weighted blanket and incentive system), it is possible to achieve low-motion fMRI data in pediatric participants (age range: 7-17 years old) undergoing a 60 min MRI session. We also observe that motion is low during the MRI protocol in a separate replication group of participants, including some with autism spectrum disorder. Collectively, the results indicate it is possible to conduct long scan protocols in difficult-to-scan populations and still achieve high-quality data, thus potentially allowing more reliable fMRI findings.
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Affiliation(s)
- Corey Horien
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA.
- MD-PhD Program, Yale School of Medicine, New Haven, CT, USA.
- Magnetic Resonance Research Center, 300 Cedar St, PO Box 208043, New Haven, CT, 06520-8043, USA.
| | | | | | | | | | | | | | | | | | - Kangjoo Lee
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Abigail S Greene
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
- MD-PhD Program, Yale School of Medicine, New Haven, CT, USA
| | - James C McPartland
- Yale Child Study Center, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Fred R Volkmar
- Yale Child Study Center, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Dustin Scheinost
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
- Yale Child Study Center, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Statistics and Data Science, Yale University, New Haven, CT, USA
| | - Katarzyna Chawarska
- Yale Child Study Center, New Haven, CT, USA
- Department of Statistics and Data Science, Yale University, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - R Todd Constable
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
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16
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Tziraki M, Garg S, Harrison E, Wright NB, Hawkes R, Akhtar K, Green J, Stivaros S. A Neuroimaging Preparation Protocol Tailored for Autism. Autism Res 2020; 14:65-74. [PMID: 33150732 DOI: 10.1002/aur.2427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
This paper describes the key basic elements required for a successful multi-parametric MRI data acquisition in awake children with autism. The procedure was designed by taking into account methodological challenges arising from the acquisition of Resting State fMRI (RS fMRI) data, and factors such as cost, time, and staff availability. The ultimate aim was to prepare an imaging preparation protocol with high transferability to the whole autism spectrum, adaptable for use in a multi-site research with multiple time points. As part of a randomized pharmaco-intervention study, 31 children aged 4-10 years with Neurofibromatosis 1 and autism underwent MR imaging at baseline and end of intervention. The protocol consisted of tailored habituation instructions including gradual exposure to scanner noise, a social stories booklet, positive incentive strategies, and Play Therapy support. Success rate for initial acquisition was 71% for GABA+ MR spectroscopy at either location, 87% for perfusion, and 67% for diffusion assessment, and 71% for RS fMRI. Qualitative data indicated that 84% parents found the habituation protocol helpful. LAY SUMMARY: Here we describe a protocol for brain Magnetic Resonance Imaging (MRI) tailored for children with ASD to help reduce stress and avoid sedation during scanning. This procedure can make advanced medical imaging more accessible and promote a better MRI experience for families of children with ASD.
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Affiliation(s)
- Maria Tziraki
- Psychology Department, CITY College, International Faculty of the University of Sheffield, Thessaloniki, Greece
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Harrison
- NIHR Clinical Research Facility, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Neville B Wright
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rob Hawkes
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kapasi Akhtar
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stavros Stivaros
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester & Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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17
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Jiwa MI, Armstrong S, Shao Y, Lunsky Y. Development of educational modules for MRTs to better support patients with intellectual and developmental disabilities undergoing imaging procedures: A collaborative patient-oriented initiative. J Med Imaging Radiat Sci 2020; 51:S26-S30. [PMID: 32943363 DOI: 10.1016/j.jmir.2020.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with intellectual and developmental disabilities (IDD) experience increased anxiety when undergoing medical imaging procedures for a variety of reasons including sensory overload, comprehension difficulty, and meeting unfamiliar people. There are several strategies that medical radiation technologists (MRTs) can apply to improve the imaging process. The purpose of this project was to work together with patients to develop educational modules and resources for MRTs on how to best support patients with IDD during medical imaging procedures. DEVELOPMENT PROCESS AND FINDINGS The project team used a four stage process to (1) determine the educational needs of MRTs around imaging procedures for people with IDD and (2) develop a series of online case-based video modules of challenges and improved practices with accompanying digital resources. First, the project team created and distributed a needs assessment survey to MRTs to identify their educational needs, experience, and interest in learning more about how to best support patients with IDD. The results from this needs assessment underscored that developing skills to better support patients with IDD was an area of interest and need amongst OAMRS members, which led to the formation of a working group whose goal was to identify priority topics and how to best teach these topics. Second, we conducted a focus group with adults with IDD, who had experience with imaging procedures, to ensure the lived experience of people with IDD was a pillar of the modules. Third, we developed a set of video scripts and educational slides, informed by the needs assessment with MRTs and the focus group with adults with IDD. The video scripts focused on four scenarios: (1) Waiting for an imaging procedure, (2) & (3) the imaging process (MRI and PET), and (4) the exit interview. Each of these videos focused on common practice errors made during these scenarios, followed by strategies to address those errors. The educational slides focused on: (1) an introduction to people with IDD (2) Communication and (3) Triggers and Strategies. The fourth and final phase focused on filming the teaching videos with actors with IDD and finalizing the educational slides. Together, the set of educational slides and videos formed the modules for MRTs that will be published online. LESSONS LEARNED Undertaking this process to develop educational modules for MRTs on working with people with IDD taught us that people with IDD have lived experiences which should inform the development of educational material; they must be treated as partners during this development process; and a partnered process takes time to carry out. CONCLUSION The process that was undertaken allowed the team to develop resources, which can be used by MRTs. Evaluation of the educational modules can inform further refinement and improvement.
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Affiliation(s)
- Muhammad Irfan Jiwa
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health
| | | | | | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health.
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