title: Imaging the "At-Risk" Brain: Future Directions.
abstract: OBJECTIVE
  Clinical neuroscience is increasingly turning to imaging the human brain for answers to a range of questions and challenges. To date, the majority of studies have focused on the neural basis of current psychiatric symptoms, which can facilitate the identification of neurobiological markers for diagnosis. However, the increasing availability and feasibility of using imaging modalities, such as diffusion imaging and resting-state fMRI, enable longitudinal mapping of brain development. This shift in the field is opening the possibility of identifying predictive markers of risk or prognosis, and also represents a critical missing element for efforts to promote personalized or individualized medicine in psychiatry (i.e., stratified psychiatry).
  
  
  METHODS
  The present work provides a selective review of potentially high-yield populations for longitudinal examination with MRI, based upon our understanding of risk from epidemiologic studies and initial MRI findings.
  
  
  RESULTS
  Our discussion is organized into three topic areas: (1) practical considerations for establishing temporal precedence in psychiatric research; (2) readiness of the field for conducting longitudinal MRI, particularly for neurodevelopmental questions; and (3) illustrations of high-yield populations and time windows for examination that can be used to rapidly generate meaningful and useful data. Particular emphasis is placed on the implementation of time-appropriate, developmentally informed longitudinal designs, capable of facilitating the identification of biomarkers predictive of risk and prognosis.
  
  
  CONCLUSIONS
  Strategic longitudinal examination of the brain at-risk has the potential to bring the concepts of early intervention and prevention to psychiatry.
authors.affiliation: 1Child Mind Institute,New York,New York.
authors.forename: Maki S
authors.initials: MS
authors.lastname: Koyama
authors.affiliation: 3The Child Study Center at NYU Langone Medical Center,New York,New York.
authors.forename: Adriana
authors.initials: A
authors.lastname: Di Martino
authors.affiliation: 2Nathan S. Kline Institute for Psychiatric Research,Orangeburg,New York.
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Castellanos
authors.affiliation: 1Child Mind Institute,New York,New York.
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Ho
authors.affiliation: 1Child Mind Institute,New York,New York.
authors.forename: Enitan
authors.initials: E
authors.lastname: Marcelle
authors.affiliation: 4Department of PsychiatryUniversity of California-San Francisco,San Francisco,California.
authors.forename: Bennett
authors.initials: B
authors.lastname: Leventhal
authors.affiliation: 1Child Mind Institute,New York,New York.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Milham
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D063132:Connectome / Q000379:methods* / Q000639:trends*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D001523:Mental Disorders / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Brain development; Longitudinal examination; Magnetic resonance imaging (MRI); Population and time window; Prediction; Stratified psychiatry