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July 22, 2020

Structural Magnetic Resonance Imaging All Over Again

Author Affiliations
  • 1Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Psychiatry. 2021;78(1):11-12. doi:10.1001/jamapsychiatry.2020.1941

You cannot be serious.

John McEnroe, 19811

In 2016, we published an article in the American Journal of Psychiatry,2 raising concerns about the interpretation of magnetic resonance imaging (MRI) acquired with pulse sequences designed to visualize brain structure. We opined that routine interpretation of data from such scans comparing patients with psychiatric diagnoses with control individuals was potentially confounded by many epiphenomena and artifacts that render conclusions about differences representing cerebral structure, ie, the basic cellular elements of the tissue, problematic if not unsubstantiated. We suggested that rather than referring to differences as evidence of brain structural abnormalities, they should be called differences on MRI measurements. Since that report, 24 studies (structural MRI and/or diffusion MRI) have appeared in JAMA Psychiatry and 22 in the American Journal of Psychiatry, describing differences in such scans in samples of psychiatric patients, and none of them have used this suggested phrase in interpretation of findings. All have concluded that the findings are evidence of potentially deleterious changes in brain structure.

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1 Comment for this article
Well done.
Laura Ebner, MD | Private Practice in Annapolis
I don’t have much to add as I am still digesting this new verbiage describing my long-delved out skepticism. We have to get the foundation right. Thank you for bringing us back there to explore the cracks.