Purpose

There is a need for biomarkers in psychiatry to improve diagnosis, prognosis and management, and with confirmed value in follow-up care. Radionuclide imaging, given its molecular imaging characteristics, is well-positioned for translation to the clinic. This systematic review lays the groundwork for integrating PET and SPECT imaging in the clinical management of schizophrenia-spectrum disorders.

Methods

Systematic search of PubMed, Embase, Web of Science and Cochrane library databases was conducted from the earliest date available until February 2024. The focus was on longitudinal studies evaluating PET or SPECT imaging in individuals with a schizophrenia-spectrum or another psychotic disorders. Quality assessment was done using the Newcastle-Ottawa Scale (NOS), NIH scale for before-after studies and Cochrane Risk of Bias tool version 2 (Cochrane RoB2). Studies were further categorised into three groups: preclinical and diagnosis, predicting disease course or personalising treatment.

Results

Fifty-six studies were included in the systematic review investigating in total 1329 patients over a median of 3 months. Over two-thirds used PET tracers, whereas the remaining studies employed SPECT tracers. The most frequently investigated system was dopaminergic transmission, followed by cerebral metabolism and blood flow. [¹⁸F]FDOPA demonstrated large effect size in predicting conversion of subjects at risk and treatment response. Additionally, treatment dosage could be optimised to reduce side effects using [¹²³I]IBZM or [¹¹C]raclopride.

Conclusion

Molecular imaging holds significant promise for real-life application in schizophrenia, with two particularly encouraging avenues being the prediction of conversion/response to antipsychotic medication and the improved management of antipsychotic dosage. Further longitudinal studies and clinical trials will be essential for validating both the clinical effectiveness and economic sustainability, as well as for exploring new applications.

中文翻译：

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精神分裂症谱系障碍临床 PET 和 SPECT 成像的 EANM 观点：纵向研究的系统评价

 目的

精神病学中需要生物标志物来改善诊断、预后和管理，并在随访护理中具有已确认的价值。鉴于放射性核素成像的分子成像特性，其非常适合转化为临床。本系统综述为将 PET 和 SPECT 成像整合到精神分裂症谱系疾病的临床管理中奠定了基础。

 方法

对 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库的系统检索从最早的可用日期开始进行，直到 2024 年 2 月。重点是纵向研究，评估患有精神分裂症谱系或其他精神障碍的个体的 PET 或 SPECT 成像。使用纽卡斯尔-渥太华量表 （NOS） 、前后研究的 NIH 量表和 Cochrane 偏倚风险工具版本 2 （Cochrane RoB2） 进行质量评估。研究进一步分为三组：临床前和诊断、预测病程或个性化治疗。

 结果

系统评价纳入了 56 项研究，在中位 3 个月内共调查了 1329 名患者。超过三分之二的研究使用了 PET 示踪剂，而其余的研究使用了 SPECT 示踪剂。最常研究的系统是多巴胺能传递，其次是脑代谢和血流。[¹⁸个地址]FDOPA 在预测有风险受试者的转化率和治疗反应方面表现出较大的效应量。此外，可以使用 [¹²³I]IBZM 或 [¹¹C] 雷氯必利优化治疗剂量以减少副作用。

 结论

分子成像在精神分裂症中的实际应用具有重要的前景，其中两个特别令人鼓舞的途径是预测对抗精神病药物的转换/反应和改善抗精神病药物剂量的管理。进一步的纵向研究和临床试验对于验证临床有效性和经济可持续性以及探索新应用至关重要。