ImportanceAdvancing precision psychiatry, where treatments are based on an individual’s biology rather than solely their clinical presentation, requires attention to several key attributes for any candidate biomarker. These include test-retest reliability, sensitivity to relevant neurophysiology, cost-effectiveness, and scalability. Unfortunately, these issues have not been systematically addressed by biomarker development efforts that use common neuroimaging tools like magnetic resonance imaging (MRI) and electroencephalography (EEG). Here, the critical barriers that neuroimaging methods will need to overcome to achieve clinical relevance in the near to intermediate term are examined.ObservationsReliability is often overlooked, which together with sensitivity to key aspects of neurophysiology and replicated predictive utility, favors EEG-based methods. The principal barrier for EEG has been the lack of large-scale data collection among multisite psychiatric consortia. By contrast, despite its high reliability, structural MRI has not demonstrated clinical utility in psychiatry, which may be due to its limited sensitivity to psychiatry-relevant neurophysiology. Given the prevalence of structural MRIs, establishment of a compelling clinical use case remains its principal barrier. By contrast, low reliability and difficulty in standardizing collection are the principal barriers for functional MRI, along with the need for demonstration that its superior spatial resolution over EEG and ability to directly image subcortical regions in fact provide unique clinical value. Often missing, moreover, is consideration of how these various scientific issues can be balanced against practical economic realities of psychiatric health care delivery today, for which embedding economic modeling into biomarker development efforts may help direct research efforts.Conclusions and RelevanceEEG seems most ripe for near- to intermediate-term clinical impact, especially considering its scalability and cost-effectiveness. Recent efforts to broaden its collection, as well as development of low-cost turnkey systems, suggest a promising pathway by which neuroimaging can impact clinical care. Continued MRI research focused on its key barriers may hold promise for longer-horizon utility.

中文翻译：

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将成像生物标志物带入精神病学的临床现实


重要性推进精准精神病学，其中治疗基于个体的生物学，而不仅仅是他们的临床表现，需要注意任何候选生物标志物的几个关键属性。这些因素包括重测可靠性、对相关神经生理学的敏感性、成本效益和可扩展性。不幸的是，使用磁共振成像 （MRI） 和脑电图 （EEG） 等常见神经成像工具的生物标志物开发工作尚未系统地解决这些问题。在这里，研究了神经影像学方法需要克服的关键障碍才能在短期到中期实现临床相关性。观察可靠性经常被忽视，这与对神经生理学关键方面的敏感性和复制的预测效用一起，有利于基于 EEG 的方法。脑电图的主要障碍是多站点精神病学联盟之间缺乏大规模数据收集。相比之下，尽管结构 MRI 可靠性高，但尚未在精神病学中证明其临床效用，这可能是由于它对精神病学相关神经生理学的敏感性有限。鉴于结构性 MRI 的普遍性，建立令人信服的临床用例仍然是其主要障碍。相比之下，低可靠性和标准化收集的难度是功能性 MRI 的主要障碍，同时需要证明其优于 EEG 的空间分辨率和直接对皮层下区域进行成像的能力实际上提供了独特的临床价值。 此外，经常缺少考虑如何平衡这些不同的科学问题与当今精神病学医疗保健提供的实际经济现实，为此，将经济建模嵌入生物标志物开发工作可能有助于指导研究工作。结论和相关性EEG 似乎最适合产生中短期临床影响，特别是考虑到其可扩展性和成本效益。最近扩大其收藏的努力以及低成本交钥匙系统的开发表明，神经影像学可以影响临床护理。专注于其关键障碍的持续 MRI 研究可能有望实现更长期的效用。