Transcranial sonography in psychiatry as a potential tool in diagnosis and research

Brain iron concentration in childhood ADHD: A systematic review of neuroimaging studies

Iron deficiency may play a role in the pathophysiology of Attention Deficit/Hyperactivity Disorder (ADHD). Due to its preponderant function in monoamine catecholamine and myelin synthesis, brain iron concentration may be of primary interest in the investigation of iron dysregulation in ADHD. This study reviewed current evidence of brain iron abnormalities in children and adolescents with ADHD using magnetic resonance imaging methods, such as relaxometry and quantitative susceptibility mapping, to assess brain iron estimates. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed for studies published between January 1, 2008 and July 7, 2023 in Medline, Scopus and Proquest. Regions of interest, brain iron index values and phenotypical information were extracted from the relevant studies. Risk of bias was assessed using a modified version of the National Heart, Lung, and Blood Institute quality assessment tool. Seven cross-sectional studies comparing brain iron estimates in children with ADHD with neurotypical children were included. Significantly reduced brain iron content in medication-naïve children with ADHD was a consistent finding. Two studies found psychostimulant use may increase and normalize brain iron concentration in children with ADHD. The findings were consistent across the studies despite differing methodologies and may lay the early foundation for the recognition of a potential biomarker in ADHD, although longitudinal prospective neuroimaging studies using larger sample sizes are required. Lastly, the effects of iron supplementation on brain iron concentration in children with ADHD need to be elucidated.

Transcranial Sonography as a Diagnostic Tool for Depressive Disorders

BACKGROUND

Transcranial sonography (TCS) is an available and noninvasive neuroimaging method that has been found to reduce the echogenicity of the brainstem raphe (BR) in patients with depression. Applying the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), we performed a meta-analysis of the diagnostic accuracy of TCS.

METHODS

A systematic search was conducted in PubMed, EMBASE, The Cochrane Library, and Web of Science. The databases were searched from inception to December 2021. The quality of the included literature was assessed using the QUADAS-2. Heterogeneity analysis was performed. A summary receiver operating characteristic (SROC) curve was generated to evaluate the diagnostic accuracy of TCS.

RESULTS

We included 12 studies with 809 patients. The pooled sensitivity was 0.66 (95% confidence interval [CI]: 0.61-0.71), and the specificity was 0.84 (95% CI: 0.80-0.87). The combined positive likelihood ratio (LR) was 3.84 (95% CI: 2.68-5.51), the negative LR was 0.41 (95% CI: 0.29-0.57), and the diagnostic odds ratio (DOR) was 11.45 (95% CI: 5.57-23.02). The area under the curve (AUC) of the plotted SROC curve was 0.86 (95% CI: 0.83-0.89). The meta-regression and subgroup analyses found no source of heterogeneity.

CONCLUSION

TCS has high potential and efficacy in diagnosing depression and may be a reasonable test to perform clinically for the assessment of depression.

Echogenicity and size of substantia nigra on transcranial sonography (TCS) in patients with attention-deficit/hyperactivity disorder and healthy children aged 6–12 years: a comparative study

Background

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders. Children with ADHD may experience significant functional problems, such as academic concerns at school, poor interpersonal relationships and low self-esteem. Current models of ADHD suggest that it is associated with functional impairments in dopamine and norepinephrine systems. The substantia nigra in the midbrain produces the largest amount of dopamine in the brain. The present study was conducted using TCS to compare the size and echogenicity of substantia nigra between ADHD and healthy children.

Results

This cross-sectional, analytical study was conducted on 68 (34 ADHD and 34 healthy individuals) aged 6–12 years. Based on the results obtained, the hyper-echogenicity of SN in control and ADHD groups were 33.3% and 66.7% (P < 0.001) and hypo-echogenicity of thalamic nuclei were 55.2% and 44.8% (P < 0.05), respectively. Interestingly, the TCS results of healthy children with a positive family history of ADHD were similar to results for patients with the disorder.

Conclusions

The echogenicity of Substantia nigra and thalamus nucleus among children and adolescents with ADHD is significantly higher from that in healthy children.

Preliminary Study of ADHD Biomarkers in Adults with Focus on Serum Iron and Transcranial Sonography of the Substantia Nigra

As previous studies have reported abnormalities in the iron indices of peripheral blood and hyperechogenicity of the substantia nigra (SN) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), we aimed to examine the same in adults with ADHD using transcranial Doppler sonography (TCS). In addition, we compared the iron indices and TCS findings before and after methylphenidate (MPH) treatment. A total of 39 participants aged ≥19 years (13 patients and 26 healthy controls) were recruited from Kyung Hee University Hospital between October 2018 and September 2019. All subjects were clinically evaluated based on the ADHD diagnostic criteria in the DSM-5, the Adult ADHD Self-Report Scale, and the Diagnostic Interview for ADHD in Adults (DIVA-5). Further, the iron indices including serum iron, ferritin, and mean platelet volume were determined. Additionally, TCS focused on the midbrain and echogenicity of the SN was conducted. Follow-up for all items was conducted for five ADHD patients after MPH treatment. Patients with ADHD had significantly lower education levels (number of years) than controls. There were no statistically significant differences in serum iron indices or the echogenic area between ADHD and control groups. Further, there were no significant changes in iron indices or TCS findings after MPH medication. Unlike previous studies, this study showed no differences between patients with ADHD and controls. Therefore, it is important to determine if these null findings were due to different target populations (children vs. adults) or other factors, including ADHD subtypes.

Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management

Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.

Transcranial B-Mode Sonography in Movement Disorders

Applying a 2-4MHz probe at the temporal bone window transcranial B-mode sonography (TCS) enables the depiction of the brain parenchyma through the intact skull. Meanwhile it has been applied for the diagnosis and the differential diagnosis of movement disorders for decades. In the first part of this chapter, we summarize the technical requirements and describe the ultrasound method for optimal TCS examination. Imaging planes and the relevant structures are explained in detail. In the second part of the chapter, we focus on the role of substantia nigra hyperechogenicity for the diagnosis of Parkinson's disease (PD) and prodromal PD. In this part, we also mention the role of TCS in atypical and secondary Parkinsonian syndromes and other movement disorders. Summarizing all these information we explain how TCS can be helpful for the differential diagnosis of movement disorders. The current data show that TCS is an easily applicable and economic imaging method which can be used as an additional tool for the diagnosis of PD with a high sensitivity (>85%), specificity (>80%) and inter-rater reliability (>84%) as well as for the differential diagnosis of movement disorders. Lately, TCS has also been utilized in further areas such as the detection of individuals at risk for PD or the determination of electrode localization in patients with deep brain stimulation. An insufficient temporal bone window especially in the elderly and the necessity of an experienced investigator are limitations of this method.