The birth of NeuroImage: Clinical

One of the great potentials of human brain imaging is to understand the links between pathophysiology of disease and disturbances in cognitive and behavioural function. Since the emergence of neuroimaging as a field in the 1970s the number of scanners and methods for analysing circuits, systems and networks has grown exponentially. We are now benefitting from an unparalleled sophistication in mathematical methods and computational tools for interrogating these rich data. The journal NeuroImage has provided an invaluable environment for vetting and promoting promising new methods and has been a home for many discoveries into normal brain function. Unfortunately, opportunities to publish clinical research involving state of the art imaging and analysis methods have been more limited. Many clinical neurology and psychiatry journals are constrained by editorial expertise that is capable of handling brain imaging involving only the simplest of analysis methods. As the brain imaging field relies more heavily on multivariate techniques, graphical analysis, morphometrics, machine learning algorithms and dynamic modelling, those journals with a more purely clinical expertise will struggle to keep abreast with the computational and conceptual changes taking place.

The editorial decision to limit clinical research at NeuroImage emerged from discussions of the editors in 2003. It was noted that, amid the growing numbers of papers submitted to the journal, a sizeable, and growing, proportion were “clinical”, using data from patients or seeking to answer questions related to specific diseases. It transpired that some of the editors had been rejecting such papers, feeling that they were inappropriate for a journal whose core strength lay in the development of methods and imaging neuroscience relating to the structure, function and development of the healthy brain. A consensus was reached to welcome the submission of clinical papers with the caveat that they should have clear implications for normal brain structure and/or function, rather as neuropsychology uses the careful study of lesions to gain insights to healthy psychological processes. Work that simply described the impact of disease or lesions using imaging measures, without trying to delve more deeply into the meaning of such altered patterns, was rejected. This distinction could be subtle, and there was real concern that the journal's policy could be perceived as inconsistent. Over subsequent years, the volume of work submitted to NeuroImage grew steadily and, as predicted, a substantial proportion of this work was clinically oriented, and subject to triage due to it falling outside of scope. Fortunately, all of the editors recognised that clinical imaging neuroscience was a quickly growing field and that, given our collective desire to reflect and nurture the development of the field in all its forms, simply ignoring a large part of clinical imaging would prevent us from publishing some of the most elegant science in the field. In addition, the appearance of remarkable new methods in image analysis amplified the potential value of clinical neuroimaging for diagnosis, identification of functional circuits and testing of pathophysiological models.

Recognising the need to foster the emerging field of clinical neuroimaging, discussions about the possibility of a clinical sister journal gathered pace from 2010 until, in May 2012, NeuroImage: Clinical was officially opened for business: an electronic, open access journal aiming to publish high-quality, clinically-oriented imaging neuroscience and employing an editorial board covering all of the key areas of this large and exciting field.

As editors, one of our aspirations for NeuroImage: Clinical is that it benefits from the sophistication in design, analysis and interpretation that fundamental research in human brain imaging has generated over the past three decades. Brain imaging in healthy populations has reached a maturity that brings with it an increasing demand for studies that move beyond “mapping” of structure–function relationships in the human brain, an enterprise that, at its crudest has been accused of descending into “blobology”. The field as a whole is increasingly acknowledging the fact that an activation study that is not under-pinned by careful hypothesis-testing will inevitably produce conclusions that are post hoc and speculative, based upon poorly-framed “reverse inference” and unlikely to offer real insights into how the brain carries out its functions or indeed how those functions are organised. The seductive powers of the brain image are increasingly recognised as potentially meretricious and one can detect growing suspicion in the popular media where neuroimaging studies have, for some time, been excitedly, and all too often, uncritically reported and extrapolated well beyond their limits. This critical scrutiny is to be welcomed: it signifies a more realistic view of the possibilities afforded by these exciting techniques and it brings us back to the bread and butter of science: using sensitive measures to test hypotheses to which those measures are most suited.

We believe that the same rigour must be applied in the clinical brain-imaging field, where the interpretive challenges are multiplied as comparisons are made across different populations. Simple group-wise differences, expressed in terms of an anomaly of structure or function, offer little explanatory value and it is hard to see how they advance our understanding of illness. At NeuroImage: Clinical, we seek hypothesis-based studies in which imaging measures are used in clever and creative, but realistic, ways in order to throw light on clinical neurological and psychiatric problems. We see the role of the journal as a cornerstone to support and nurture this scientific area, offering a platform to optimise the impact of emergent findings and to offer, too, the opportunity for scientists to shape and direct critical areas through the publication of review and perspective articles. As a sister journal to NeuroImage, we are in a unique position of being able to draw on the talents of a remarkable pool of expert reviewers and editors who have made NeuroImage the home to some of the most sophisticated and inspiring brain imaging research known. This support allows us to make NeuroImage: Clinical a safe haven for clinical imaging research involving “bleeding edge” methods that push the boundaries of discovery.