New data published in JAMA Psychiatry argues that MRI brain scans should be routinely included in the initial clinical workups of patients presenting with first-episode psychosis [1].
Experts recently conducted a meta-analysis that included more than 1,600 patients with FEP who underwent brain MRI during their initial assessment to determine whether instances of clinically relevant neuroradiological abnormalities could be linked to patients’ symptoms. Of those, 26.4% showed an intracranial radiological abnormality, some of which resulted in a change in clinical management.
Because several causes of secondary psychosis can result in structural brain abnormalities, experts involved in the study suggested that MRI exams warrant consideration in protocols related to FEP.
“Individuals presenting with first-episode psychosis may have a secondary (“organic”) etiology to their symptoms that can be identified using neuroimaging,” corresponding author Graham Blackman, MBChB, with the Department of Psychiatry at the University of Oxford (UK), and colleagues explained. “Because failure to detect such cases at an early stage can have serious clinical consequences, it has been suggested that brain magnetic resonance imaging should be mandatory for all patients presenting with FEP.”
The meta-analysis included 12 studies with a combined total of 1,613 patients who underwent MRI as part of their FEP assessment. Of the 26.4% who showed abnormalities on imaging, 6% had their treatment plans altered due to findings that were considered clinically relevant, the most common of which were reported as white matter abnormalities.
“This finding is consistent with independent neuroimaging evidence that psychosis is associated with widely distributed anatomical and functional dysconnectivity,” the group noted. “White matter lesions are closely associated with neuroinflammatory processes in psychosis, as well as immune-mediated neurological disorders such as multiple sclerosis, supporting an etiological role of the immune system in psychosis.”
There are other factors that merit consideration with respect to scanning all FEP patients, such as costs and feasibility, since clinically relevant radiologic findings in these patients are not incredibly common—occurring in just one out of every 18 patients scanned in this analysis.
Costs for MRI exams vary widely based on location, insurance, etc.; the authors estimated that in Europe it would cost approximately $4,752 (€4,500) to detect one relevant abnormality. In the United States, that figure would be significantly more. However, the group maintained that the cost of missing such findings is likely higher. Further work needs to be done to better understand the net economic benefits but the group suggested that in the interim, their findings support offering MRI to all FEP patients.
The detailed study is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.