Advanced neuroimaging

Advances in neuroimaging are improving our understanding of, and diagnostic approach to, many neurologic and neuropsychiatric conditions by identifying disturbances in brain structure and/or function that underlie neurobehavioral disturbances. In addition to detailed structural information, some types of advanced neuroimaging also provide non-invasive assessments of the metabolic and biochemical characteristics of brain tissue. Although some of these techniques are primarily used for research purposes, advanced neuroimaging methods are increasingly being applied to the evaluation and management of persons with neuropsychiatric disorders. As discussed in Chapter 26, conventional neuroimaging is used routinely in the practice of Behavioral Neurology & Neuropsychiatry (BN&NP) and its application in clinical contexts is a core clinical competency in this field [1]. There is increasing interest in the application of more recently developed magnetic resonance imaging (MRI) techniques such as diffusion tensor imaging (DTI), diffusion spectrum imaging (DSI), magnetic resonance spectroscopy (MRS), arterial spin labeling (ASL), functional MRI (fMRI), and functional connectivity MRI (fcMRI) to clinical practice. At the present time, however, the use of these techniques in clinical medicine is neither widespread nor generally accepted. Nuclear medicine technologies, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET), are applied in select circumstances to the practice of BN&NP and they remain commonly employed research techniques. Although advanced neuroimaging techniques may not be used commonly by many BN&NP subspecialists, a basic understanding of these techniques is essential [1] for practitioners in this field.