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Magnetic resonance advanced imaging analysis in adolescents: cortical thickness study to identify attenuated psychosis syndrome

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Psychosis is a symptom common to several mental illnesses and a defining feature of schizophrenia spectrum disorders, whose onset typically occurs in adolescence. Neuroradiological studies have reported evidence of brain structural abnormalities in patients with overt psychosis. However, early identification of brain structural changes in young subjects at risk for developing psychosis (such as those with Attenuated Psychosis Syndrome –APS) is currently lacking.

Methods

Brain 3D T1-weighted and 64 directions diffusion-weighted images were acquired on 55 help-seeking adolescents (12–17 years old) with psychiatric disorders who referred to our Institute. Patients were divided into three groups: non-APS (n = 20), APS (n = 20), and Early-Onset Psychosis (n = 15). Cortical thickness was calculated from T1w images, and Tract-Based Spatial Statistics analysis was performed to study the distribution of white matter fractional anisotropy and all diffusivity metrics. A thorough neuropsychological test battery was adopted to investigate cognitive performance in several domains.

Results

In patients with Attenuated Psychotic Syndrome, the left superior frontal gyrus was significantly thinner compared to patients with non-APS (p = 0.048), and their right medial orbitofrontal cortex thickness was associated with lower working memory scores (p = 0.0025, r = -0.668 for the working memory index and p = 0.001, r = -0.738 for the digit span). Early-Onset Psychosis patients showed thinner left pars triangularis compared to non-APS individuals (p = 0.024), and their left pars orbitalis was associated with impaired performance at the symbol search test (p = 0.005, r = -0.726). No differences in diffusivity along main tracts were found between sub-groups (p > 0.05).

Conclusion

This study showed specific associations between structural imaging features and cognitive performance in patients with APS. Characterizing this disorder using neuroimaging could reveal useful information that may aid in the development and evaluation of preventive strategies in these individuals.

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Data availability

The data that support the findings of this study are available from the corresponding author upon request (https://doi.org/10.5281/zenodo.6563681).

Abbreviations

AD:

Axial Diffusivity

APS:

Attenuated Psychosis Syndrome

BLIPS:

Brief Limited Intermittent Psychotic Symptoms

CAARMS:

Comprehensive Assessment of At-Risk Mental State

CC:

Core-Coding

CHR-P:

Clinical High-Risk state for Psychosis

CGI-S:

Clinical Global Impression-Severity

CT:

Cortical Thickness

DS:

Digit Span

DSM-5:

Diagnostic and Statistical Manual of mental disorders, Fifth edition

DTI:

Diffusion Tensor Imaging

DUP:

Duration of Untreated Psychosis

EOP:

Early-Onset Psychosis

FA:

Fractional Anisotropy

FMRIB:

Functional Magnetic Resonance Imaging of the Brain

FSL:

FMRIB Software Library

GRD:

Genetic Risk and Deterioration syndrome

HARDI:

High Angular Resolution Diffusion-weighted Imaging

IQ:

Intelligence Quotient

K-SADS-PL:

Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime version

LN:

Letter-Number sequencing

MD:

Mean Diffusivity

MNI:

Montreal Neurological Institute

MRI:

Magnetic Resonance Imaging

non-APS:

Non-Attenuated Psychotic Syndrome

PS:

Processing Speed

RD:

Radial Diffusivity

SCID-5-PD:

Structured Clinical Interview for DSM-5 Personality Disorders

sd:

standard deviation

SE-EPI:

Spin-Echo EchoplanarImaging

SES:

Socio-Economical Status

SOFAS:

Social and Occupational Functioning Assessment Scale

SS:

Symbol Search

TBSS:

Tract-Based Spatial Statistics

TFCE:

Threshold Free Cluster Enhancement

WAIS:

Wechsler Adult Intelligence Scale

WISC:

Wechsler Intelligence Scale for Children

WM:

Working Memory

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Acknowledgements

We thank the patients and their families for their collaboration.

Funding

We thank the Italian Ministry of Health for the financial support by RC 2017–2019 and 2020–2021.

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Authors and Affiliations

  1. Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy

    Luca Melazzini

  2. Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy

    Laura Mazzocchi, Matteo Paoletti, Stefano Bastianello & Anna Pichiecchio

  3. Child and Adolescent Neuropsychiatric Unit, IRCCS Mondino Foundation, Pavia, Italy

    Arianna Vecchio, Martina M. Mensi & Renato Borgatti

  4. Faculty of Medicine and Surgery, Department of Molecular Medicine, University of Pavia, Pavia, Italy

    Alexandra Paredes

  5. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Martina M. Mensi, Stefano Bastianello, Umberto Balottin, Renato Borgatti & Anna Pichiecchio

  6. BioData Science Unit, IRCCS Mondino Foundation, Pavia, Italy

    Elena Ballante

  7. Department of Political and Social Sciences, University of Pavia, Pavia, Italy

    Elena Ballante

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Contributions

Conception and study design: Martina Maria Mensi, Umberto Balottin, Renato Borgatti and Anna Pichiecchio; data collection or acquisition: Laura Mazzocchi, Arianna Vecchio, Alexandra Paredes and Matteo Paoletti; statistical analysis: Laura Mazzocchi and Elena Ballante; interpretation of results: Luca Melazzini, Laura Mazzocchi, Arianna Vecchio, Alexandra Paredes, Martina Maria Mensi, Elena Ballante, Matteo Paoletti and Anna Pichiecchio; original draft preparation, review and editing: Luca Melazzini, Laura Mazzocchi, Arianna Vecchio, Alexandra Paredes, Matteo Paoletti, Renato Borgatti and Anna Pichiecchio. All authors read and approved the final version of the manuscript and agree to be accountable for the integrity and accuracy of all aspects of the work.

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Correspondence to Laura Mazzocchi.

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This study was approved by the Ethics Committee of the IRCCS Mondino Foundation and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Luca Melazzini and Laura Mazzocchi are co-first authors.

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Melazzini, L., Mazzocchi, L., Vecchio, A. et al. Magnetic resonance advanced imaging analysis in adolescents: cortical thickness study to identify attenuated psychosis syndrome. Neuroradiology 65, 1447–1458 (2023). https://doi.org/10.1007/s00234-023-03200-2

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