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This Neuroimaging Method Has 100% Diagnostic Accuracy (Or Your Coin Back)

This Neuroimaging Method Has 100% Diagnostic Accuracy (Or Your Coin Back)
Posted By : Margaret Garland
Category : lainnya

doi:10.1371/journal.pone.0129659.g003

Did you lot know that SPECT imaging tin lav diagnose PTSD amongst 100% accuracy (Amen et al., 2015)? Not entirely that, out of a sample of 397 patients from the Amen Clinic inwards Newport Beach, SPECT was able to distinguish betwixt 4 dissimilar groups amongst 100% accuracy! That's right, the scans of (1) good for you lot participants, as well as patients amongst (2) classic post-traumatic stress disorder (PTSD), (3) classic traumatic encephalon injury (TBI), as well as (4) both disorders..... were all classified amongst 100% accuracy!

TRACK-TBI investigators, your 3T structural as well as functional MRI lawsuit measures are obsolete.

NIMH, the hard piece of job of developing biomarkers for mental affliction is done, you lot tin lav close downward now. Except none of this inquiry was funded yesteryear you...

The finding was #19 inwards a listing of the top 100 stories yesteryear Discover Magazine.


How could the Amen Clinics, a for-profit commercial enterprise, attain what an Earth forces of investigators amongst billions inwards federal funding could not?

The authors1 relied on a large database of scans collected from multiple sites over a xx yr period. The amount sample included 20,746 individuals who visited i of nine Amen Clinics from 1995-2014 for psychiatric and/or neurological evaluation (Amen et al., 2015). The showtime analysis included a smaller, highly selected sample matched on a number of dimensions, including psychiatric comorbidities (Group 1).

- click on epitome for larger thought -


You'll notice the per centum of patients amongst ADHD was remarkably high (58%, matched across the 3 patient groups). Perhaps that's because...


I did non know that.
 Featuring Johnny Cash ADD.


SPECT uses a radioactive tracer injected thirty minutes earlier a scan that volition assess either the “resting state” or an “on-task” status (a continuous functioning task, inwards this study). Clearly, SPECT is not the go-to method if you're looking for decent temporal resolution to compare 2 weather condition of an active attending task. The authors used a part of involvement (ROI) analysis to mensurate tracer activeness (counts) inwards specific encephalon regions.

I wondered nearly the circularity of the clinical diagnosis (i.e., were the SPECT scans used to assist diagnosis), especially since “Diagnoses were made yesteryear board certified or eligible psychiatrists, using all of the information available to them, including detailed clinical history, mental status exam as well as DSM-IV or V criteria...” But nosotros were assured that wasn't the case: “These quantitative ROI metrics were inwards no way used to assist inwards the clinical diagnosis of PTSD or TBI.” The residuum of the methods (see Footnote 2) were opaque to me, every bit I know naught nearly SPECT.

H5N1 2nd analysis relied on visual readings (VR) of nearly thirty cortical as well as subcortical ROIs. “Raters did non receive got access to detailed clinical information, simply did know age, gender, medications, as well as main presenting symptoms (ex. depressive symptoms, apathy, etc.).”  Hmm...

But the quantitative ROI analysis gave superior results to the clinician VR. So superior, inwards fact, that the sensitivity/specificity inwards distinguishing i grouping from some other was 100% (indicated yesteryear cherry boxes below). The VR distinguished patients from controls amongst 100% accuracy, simply was non every bit skilful for classifying the dissimilar patient groups during the resting solid soil scan entirely a measly 86% sensitivity, 81% specificity for TBI vs. PTSD, which is however much amend than other studies. However, results from the massively sized Group 2 were completely unimpressive. 3


- click on epitome for larger view, you'll desire to consider this -



Why is this then important? PTSD as well as TBI tin lav demonstrate overlapping symptoms inwards country of war veterans as well as civilians alike, as well as the disorders tin lav co-occur inwards the same individual. More accurate diagnosis tin lav Pb to amend treatments. This active surface area of research is nicely reviewed inwards the paper, simply no major breakthroughs receive got been reported yet. So the claims of Amen et al. are remarkable. Stunning if true. But they're not. They can't be. The accuracy of the classifier exceeds the precision of the measurements, then this can't hold upward possible. What is the test-retest reliability of SPECT? What is the concordance across sites? Was at that spot no alter inwards imaging protocol, no improvements or upgrades to the equipment over xx years? SPECT is sensitive to motion artifact, then how was that handled, especially inwards patients who purportedly receive got ADHD?

SPECT has been noted for its miserable spatial resolution compared to other functional neuroimaging techniques similar PET as well as fMRI. H5N1 panel of Neurobollocks) for making unsubstantiated claims nearly the diagnostic accuracy as well as usefulness of SPECT.

Are his latest results likewise skilful to hold upward true? You tin lav banking concern check for yourself! The newspaper was published inwards PLOS ONE, which has an open information policy:
PLOS journals require authors to laid upward all information underlying the findings described inwards their manuscript fully available without restriction, amongst rare exception.

When submitting a manuscript online, authors must furnish a Data Availability Statement describing compliance amongst PLOS's policy. If the article is accepted for publication, the information availability arguing volition hold upward published every bit constituent of the finally article.

Before you lot instruct likewise excited, here's the Data Availability Statement:
Data Availability: All relevant information are inside the paper.

But this is non true. NONE of the information are available inside the paper. There's no way to reproduce the authors' analyses, or to behave your own. This is a problem, because...
Refusal to portion information as well as related metadata as well as methods inwards accordance amongst this policy volition hold upward grounds for rejection. PLOS mag editors encourage researchers to contact them if they run across difficulties inwards obtaining information from articles published inwards PLOS journals. If restrictions on access to information come upward to calorie-free afterwards publication, nosotros reserve the right to postal service a correction, to contact the authors' institutions as well as funders, or inwards extreme cases to retract the publication.

So all you lot “research parasites” out there4 you lot tin lav asking the data. I idea this small-scale proposal would create a brouhaha until I saw a 2014 press unloosen announcing the World's Largest Database of Functional Brain Scans Produces New Insights to Help Better Diagnose as well as Treat Mental Health Issues:
With a generous grant from the Seeds Foundation [a Christian philanthropic organization] inwards Hong Kong, MD Amen as well as his inquiry squad led yesteryear neuroscientist Kristen Willeumier, PhD, receive got turned the de-identified scans as well as clinical information into a searchable database that is shared amongst other researchers to a greater extent than or less the world.

In the finally 2 years, Amen as well as colleagues receive got presented 20 posters at the National Academy of Neuropsychology. The PR continues:
The magnitude as well as clinical significance of the Amen Clinics database – existence the world's largest SPECT imaging database having such book as well as breadth of information from patients nine months former to 101 years of historic catamenia – makes it a treasure trove for researchers to assist advance as well as revolutionize the practise of psychiatry.

Does this hateful that MD Amen volition grant you lot access to the PLOS ONE dataset (or to the entire Amen Clinics database) if you lot inquire nicely? If anyone tries to do this, delight exit a comment.


Footnotes

1 The other authors included MD Andrew “Neurobollocks) for making unsubstantiated claims nearly the diagnostic accuracy as well as usefulness of SPECT.

Are his latest results likewise skilful to hold upward true? You tin lav banking concern check for yourself! The newspaper was published inwards PLOS ONE, which has an open information policy:
PLOS journals require authors to laid upward all information underlying the findings described inwards their manuscript fully available without restriction, amongst rare exception.

When submitting a manuscript online, authors must furnish a Data Availability Statement describing compliance amongst PLOS's policy. If the article is accepted for publication, the information availability arguing volition hold upward published every bit constituent of the finally article.

Before you lot instruct likewise excited, here's the Data Availability Statement:
Data Availability: All relevant information are inside the paper.

But this is non true. NONE of the information are available inside the paper. There's no way to reproduce the authors' analyses, or to behave your own. This is a problem, because...
Refusal to portion information as well as related metadata as well as methods inwards accordance amongst this policy volition hold upward grounds for rejection. PLOS mag editors encourage researchers to contact them if they run across difficulties inwards obtaining information from articles published inwards PLOS journals. If restrictions on access to information come upward to calorie-free afterwards publication, nosotros reserve the right to postal service a correction, to contact the authors' institutions as well as funders, or inwards extreme cases to retract the publication.

So all you lot “research parasites” out there4 you lot tin lav asking the data. I idea this small-scale proposal would create a brouhaha until I saw a 2014 press unloosen announcing the Glossolalia” Newberg as well as MD Theodore “Neuro-Luminance Synaptic Space” Henderson.

2 Methods:
To concern human relationship for outliers, T-score derived ROI count measurements were derived using trimmed agency [91] that are calculated using all scores inside the 98% confidence interval (-2.58 < Z < -2.58). The ROI hateful for each dependent area as well as the trimmed hateful for the sample are used to calculate T amongst the next formula: T = 10*((subject ROI_mean - trimmed regional_avg)/trimmed regional_stdev)+50.
3 Results from the less pristine Group 2 were non impressive at all, I must say. Group 2 had TBI (n=7,505), PTSD (n=1,077), or both (n=1,017) compared to n=11,147 patients without either (these were non laid upward clean controls every bit inwards Group 1). Given the massive number of subjects, the results were clinically useless, for the most constituent (see Table 6).

4 H5N1 laid upward novel editorial inwards NEJM yesteryear Longo as well as Drazen (who decry “research parasites”) is causing a twitterstorm amongst the hashtags #researchparasites as well as #IAmAResearchParasite.


References

Adinoff B, Devous M. (2010a). Scientifically unfounded claims inwards diagnosing as well as treating patients. Am J Psychiatry 167(5):598.

Adinoff B, Devous M. (2010b). Response to Amen letter. Am J Psychiatry 167(9):1125-1126.

Amen, D., Raji, C., Willeumier, K., Taylor, D., Tarzwell, R., Newberg, A., & Henderson, T. (2015). Functional Neuroimaging Distinguishes Posttraumatic Stress Disorder from Traumatic Brain Injury inwards Focused as well as Large Community Datasets PLOS ONE, 10 (7) DOI: 10.1371/journal.pone.0129659

Chancellor B, Chatterjee A. (2011). Brain branding: When neuroscience as well as commerce collide. AJOB Neuroscience 2(4): 18-27.

Farah MJ. (2009). A moving-picture demonstrate is worth a yard dollars. J Cogn Neurosci. 21(4):623-4.
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