Skin Malignancies: Imaging Review with Radiologic-Histopathologic Correlation.

Skin malignancies are commonly encountered as primary or incidental findings. Neoplasms that affect the skin include primary (basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma) and secondary (mesenchymal neoplasms, lymphoma, and metastases) tumors. Imaging provides valuable anatomic information (tumor size, depth of involvement, presence of distant metastasis, and data for guiding biopsy) and functional information (metabolic activity and sentinel node mapping data). This information, in addition to biopsy results, improves the histopathologic characterization of tumors and treatment planning. Various histopathologic types of the same entity exhibit different biologic behavior and have different imaging features. Familiarity with the multimodality imaging features, histopathologic characteristics, and various modes of dissemination (direct invasion; perineural, lymphatic, and hematogenous spread) of the most common skin malignancies helps radiologists narrow the differential diagnosis in clinical practice. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Identification of the Somatomotor Network from Language Task-based fMRI Compared with Resting-State fMRI in Patients with Brain Lesions.

Background Resting-state functional MRI (rs-fMRI) is a potential alternative to task-based functional MRI (tb-fMRI) for somatomotor network (SMN) identification. Brain networks can also be generated from tb-fMRI by using independent component analysis (ICA). Purpose To investigate whether the SMN can be identified by using ICA from a language task without a motor component, the sentence completion functional MRI (sc-fMRI) task, compared with rs-fMRI. Materials and Methods The sc-fMRI and rs-fMRI scans in patients who underwent presurgical brain mapping between 2012 and 2016 were analyzed, using the same imaging parameters (other than scanning time) on a 3.0-T MRI scanner. ICA was performed on rs-fMRI and sc-fMRI scans with use of a tool to separate data sets into their spatial and temporal components. Two neuroradiologists independently determined the presence of the dorsal SMN (dSMN) and ventral SMN (vSMN) on each study. Groups were compared by using t tests, and logistic regression was performed to identify predictors of the presence of SMNs. Results One hundred patients (mean age, 40.9 years ± 14.8 [standard deviation]; 61 men) were evaluated. The dSMN and vSMN were identified in 86% (86 of 100) and 76% (76 of 100) of rs-fMRI scans and 85% (85 of 100) and 69% (69 of 100) of sc-fMRI scans, respectively. The concordance between rs-fMRI and sc-fMRI for presence of dSMN and vSMN was 75% (75 of 100 patients) and 53% (53 of 100 patients), respectively. In 10 of 14 patients (71%) where rs-fMRI did not show the dSMN, sc-fMRI demonstrated it. This rate was 67% for the vSMN (16 of 24 patients). Conclusion In the majority of patients, independent component analysis of sentence completion task functional MRI scans reliably demonstrated the somatomotor network compared with resting-state functional MRI scans. Identifying target networks with a single sentence completion scan could reduce overall functional MRI scanning times by eliminating the need for separate motor tasks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Field and Birn in this issue.

Musculoskeletal Radiology Reports: Overlooked or Valuable?

The electronic medical record (EMR) can reveal preferences of clinicians regarding imaging services. We sought to evaluate viewing habits for reports and images of musculoskeletal (MSK) studies by ordering clinicians. We hypothesized that MSK reports are important to clinical management, especially for advanced imaging modalities. We tracked the image and report access of all MSK studies ordered in September 2016 over 8 months using logs of the EMR (Epic Systems, Verona, WI), and by an independent analysis of the institutional PACS (Picture Archiving and Communication Systems) (Carestream Health, Rochester, NY). The time stamps were extracted for when images and reports were viewed. We categorized MSK studies by modality and provider department. We also compared the rates of viewing reports and images among different modalities and departments using the chi-square test. Of the 8143 viewed MSK studies, 7842 (96.3%) reports (with/without images) and 3916 (48.1%) imaging data (with/without reports) were viewed. Viewing reports alone occurred in 4227 (51.9%) studies. CT and MRI reports alone views occurred more often in comparison to radiographs ([482/706; 68.3%] for CT and [981/1713; 57.3%] for MRI vs. [2764/5724; 48.3%] for radiography, p < 0.001). Orthopedists ordered the highest number of MSK studies and viewed reports 99.2% (3216/3242) of the time, including a 54.6% (1770/3242) rate of viewing reports alone and a 44.6% (1446/3242) rate of viewing both reports and images. They viewed images without reports in 0.8% (27/3242) of cases. MSK reports were viewed significantly more frequently than the images across all modalities and all relevant specialties.

Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder.

OBJECTIVE: Some individuals with functional neurological disorder (FND) exhibit motor and affective disturbances, along with limbic hyper-reactivity and enhanced motor-limbic connectivity. Given that the multimodal integration network (insula, dorsal cingulate, temporoparietal junction (TPJ)) is implicated in convergent sensorimotor, affective and interoceptive processing, we hypothesised that patients with FND would exhibit altered motor and amygdalar resting-state propagation to this network. Patient-reported symptom severity and clinical outcome were also hypothesised to map onto multimodal integration areas. METHODS: Between-group differences in primary motor and amygdalar nuclei (laterobasal, centromedial) were examined using graph-theory stepwise functional connectivity (SFC) in 30 patients with motor FND compared with 30 healthy controls. Within-group analyses correlated functional propagation profiles with symptom severity and prospectively collected 6-month outcomes as measured by the Screening for Somatoform Symptoms Conversion Disorder subscale and Patient Health Questionnaire-15 composite score. Findings were clusterwise corrected for multiple comparisons. RESULTS: Compared with controls, patients with FND exhibited increased SFC from motor regions to the bilateral posterior insula, TPJ, middle cingulate cortex and putamen. From the right laterobasal amygdala, the FND cohort showed enhanced connectivity to the left anterior insula, periaqueductal grey and hypothalamus among other areas. In within-group analyses, symptom severity correlated with enhanced SFC from the left anterior insula to the right anterior insula and TPJ; increased SFC from the left centromedial amygdala to the right anterior insula correlated with clinical improvement. Within-group associations held controlling for depression, anxiety and antidepressant use. CONCLUSIONS: These neuroimaging findings suggest potential candidate neurocircuit pathways in the pathophysiology of FND.

Fearful Attachment Linked to Childhood Abuse, Alexithymia, and Depression in Motor Functional Neurological Disorders.

Insecure attachment is a predisposing risk factor for the development of functional neurological disorder (FND). There is limited research investigating connections between attachment styles, other predisposing vulnerabilities, and symptom severity in patients with motor FND. By using a within-group design with prospective data collection, the authors performed univariate tests followed by multivariate linear regressions to investigate neuropsychiatric factors associated with four attachment styles (secure, fearful, preoccupied, and dismissing) among 56 patients with motor FND (mean age=40.2 years [SD=13.0]; women, N=41; men, N=15). In univariate analyses, fearful attachment style was associated with self-reported adverse life event burden, alexithymia, dissociation, depression, anxiety, impaired stress coping skills, functional neurologic symptom severity, and marital status. In a multivariate stepwise linear regression analysis, childhood abuse, alexithymia, depression, and not being married independently predicted fearful attachment. In a post hoc analysis, childhood sexual and emotional abuse were each independently associated with fearful attachment tendencies. There were no independent predictors of secure, preoccupied, or dismissing attachment styles in this study population. Future studies with larger cohorts are needed to investigate nuanced relationships among predisposing vulnerabilities for the development of FND, as well as potential links between risk factors, functional neurologic symptom severity, and clinical outcomes.

Secure Attachment and Depression Predict 6-Month Outcome in Motor Functional Neurological Disorders: A Prospective Pilot Study.

BACKGROUND: The relationships between baseline neuropsychiatric factors and clinical outcome in patients with functional neurological disorder (FND)/conversion disorder remain poorly understood. OBJECTIVE: This prospective, naturalistic pilot study investigated links between predisposing vulnerabilities (risk factors) and clinical outcome in patients with motor FND engaged in usual care within a subspecialty FND clinic. METHODS: Thirty-four patients with motor FND were enrolled and completed baseline and 6-month follow-up psychometric questionnaires. Univariate screening tests followed by multivariate linear regression analyses were used to investigate neuropsychiatric predictors of 6-month clinical outcome in patients with motor FND. RESULTS: In univariate analyses, baseline secure attachment traits and depression as measured by the Relationship Scales Questionnaire and Beck Depression Inventory-II positively correlated with improved Patient Health Questionnaire-15 scores. In a multivariate linear regression analysis adjusting for the interval time between baseline and follow-up data collection, baseline secure attachment and depression scores independently predicted improvements in Patient Health Questionnaire-15 scores. In additional analyses, patients with a diagnosis of psychogenic nonepileptic seizures compared to individuals with other motor FND subtypes showed a trend toward worse 6-month physical health outcomes as measured by the Short Form Health Survey-36. CONCLUSION: Future large-scale, multi-site longitudinal studies are needed to comprehensively investigate neuropsychiatric predictors of clinical outcome in patients with motor FND, including functional weakness, functional movement disorders, and psychogenic nonepileptic seizures.

Improving Radiology Trainees' Perception Using Where's Waldo?

RATIONALE AND OBJECTIVES: Perception is an essential skill leading to expertise in diagnostic radiology. We determined if practicing "Where's Waldo?" images improves accuracy and speed with which first and second year radiology residents detect abnormalities on chest radiographs (CXRs). MATERIALS AND METHODS: Residents at three institutions were pretested using 50 CXRs, identifying locations of potential abnormalities. They were then split into trained (examining 7 "Where's Waldo?" images over three weeks) and control groups (no "Where's Waldo?"). They were then re-tested on the 50 CXRs. At one site, visual search parameters were acquired. Data were analyzed with repeated measures ANOVAs. RESULTS: There was no significant difference in performance for trained vs control (F = 0.622, p = 0.436), with both improving significantly on post-test (F = 4.72, p = 0.037). Session time decreased significantly for both groups from pre to post-test (F = 81.47, p < 0.0001) and the decrease was significantly more (F = 31.59, p < 0.0001) for the trained group than the control group as well as for PGY with PGY3 having a larger average decrease in session time than PGY2. Eye-tracking data also showed significant increases in per image search efficiency with training. CONCLUSION: Practicing "Where's Waldo?" or similar nonradiology search tasks may facilitate the acquisition of radiology image search but not detection skills, impacting reading efficiency more than detection accuracy.

Value of acute neurovascular imaging in patients with suspected transient ischemic attack.

PURPOSE: Acute neurovascular imaging including MRA and/or CTA are routinely performed in the emergency departments (ED) for patients who present with suspected transient ischemic attacks (TIA). Given the current emphasis on mitigating the rising cost of health care nationally, and promoting high value practice, we sought to determine 1) the value of acute neurovascular imaging in patients presenting to the ED with TIA-like symptoms, and 2) whether these neurovascular studies led to a difference in management strategies. METHOD: We retrospectively reviewed 398 ED patients who presented with transient neurological deficits and underwent neurovascular imaging from 2015 to 2018. We reviewed diffusion weighted imaging (DWI) and neurovascular results by patient demographics, baseline risk factors, final diagnosis, treatment/management dispositions and three-month follow-up. RESULTS: 28.1% (112/398) of patients were diagnosed with true TIA, whereas 71.9% patients were deemed to have a non-vascular etiology. Total rates of positive MRA/CTA for severe intracranial (>50%) and cervical vessel (>70%) stenosis were 10.5% and 1.7%. Patients with positive DWI scans had significantly higher rates of severe vascular stenosis (24.4% versus 7.8% intracranially and 2.4% versus 0.9% in the neck) compared to those with negative DWI scans. All patients were treated with multi-pronged medical therapies with no immediate surgical intervention. A follow-up stroke was equally likely in TIA patients with or without severe vascular stenosis. CONCLUSIONS: In patients presenting with TIA-like symptoms and DWI negative scans, the overall rate of positive neurovascular studies is very low. Triaging with DWI can reduce the frequency of unnecessary neurovascular imaging.

Creating joy in the workplace.

Creating a joyful workplace is not the same as dealing with issues of stress, fatigue, burn-out, and resilience. It requires a proactive approach to augment feelings of worth, appreciation, and well-being in the members of the team. The sense that one is pursuing worthwhile, valuable activities requires a wholesale commitment to the mission, vision and values of the organization. These tenets are often created through an organic consensus of collegial workmates and then put to action by a leadership team. Reassessing the goals and virtues of the organization at appropriate intervals leads to ongoing loyalty and commitment to the team and a positive attitude. Well-being is addressed through the creation of a bright and cheerful physical and psychosocial workplace that offers programs that encourage mindfulness, humor, playfulness, and fitful lifestyle choices. The sense that one's work is appreciated and valued stems from an attitude of gratitude on behalf of all levels of the organization including management and peers where such encouragement flourishes. Those expressions of appreciation may be in the form of celebrations in the workplace and/or compensation and benefits that appropriately value the contributions of the employee. The organization's executive team should be dedicated to crafting an environment that leads to delighted, healthy employees.

Which vendor is most cited in the hepatic imaging literature?

PURPOSE: When deciding among imaging equipment vendors, one may use a vendor's prevalence in peer-reviewed publications as a measure of their research and development. We sought to determine which vendors, countries, and journals were dominant in hepatic imaging literature of 2018 with respect to magnetic resonance (MR), computed tomography (CT), and ultrasound (US). METHODS: We recorded and analyzed the modality (MR, CT, US), journal, vendor, and authors' country for all original hepatic imaging articles published in 2018 in 29 imaging journals. RESULTS: Of 197 MR articles, investigators used Siemens in 98 (50%), General Electric (GE) in 65 (33%), and Philips in 63 (32%). Of 115 CT articles, investigators mentioned Siemens in 55 (48%), GE in 45 (39%), Philips in 25 (22%) and other vendors in 27 (24%). Of 68 ultrasound articles, Siemens dominated with 27 (40%), versus GE with 19 (28%), Philips with 11 (16%), and other vendors with 42 (62%). We found a significant difference in vendor usage for MR, CT, and all modalities (p < .01). The plurality of articles was written in the United States (73 [23%]) with South Korea (56 [17%]) and China (56 [17%]) following. European Radiology published the most hepatic articles. For American journals, we found a significant difference in MR (p = .02) and CT (p < .01) vendor usage, whereas non-American journals nearly reached significance in MR (p = .06) and CT (p = .06) vendor usage. CONCLUSION: Siemens was the most cited vendor in hepatic imaging literature for all modalities. American institutions and non-American journals published the most hepatic imaging articles.

Role of Functional Magnetic Resonance Imaging in the Presurgical Mapping of Brain Tumors.

When planning for brain tumor resection, a balance between maximizing resection and minimizing injury to eloquent brain parenchyma is paramount. The advent of blood oxygenation level-dependent functional magnetic resonance (fMR) imaging has allowed researchers and clinicians to reliably measure physiologic fluctuations in brain oxygenation related to neuronal activity with good spatial resolution. fMR imaging can offer a unique insight into preoperative planning for brain tumors by identifying eloquent areas of the brain affected or spared by the neoplasm. This article discusses the fMR imaging techniques and their applications in neurosurgical planning.

Dynamic Brain Connectivity in Resting State Functional MR Imaging.

Dynamic functional connectivity adds another dimension to resting-state functional MR imaging analysis. In recent years, dynamic functional connectivity has been increasingly used in resting-state functional MR imaging, and several studies have demonstrated that dynamic functional connectivity patterns correlate with different physiologic and pathologic brain states. In fact, evidence suggests that dynamic functional connectivity is a more sensitive marker than static functional connectivity; therefore, it might be a promising tool to add to clinical functional neuroimaging. This article provides a broad overview of dynamic functional connectivity and reviews its general principles, techniques, and potential clinical applications.

Fellowship Candidate Factors Considered by Program Directors.

OBJECTIVE: The neuroradiology fellowship match has been in existence for about 20 years. However, the elements by which neuroradiology fellowship program directors evaluate candidates have not been clearly elucidated. We sought to identify the factors that program directors use to rank neuroradiology fellowship applicants. METHODS: An anonymous Qualtrics online five-question survey about educational credentials, personal traits, extracurricular activities, and demographic characteristics was sent to 72 neuroradiology program directors in April 2019. Each question required ranking of 10 factors based on different characteristics of fellowship candidates. Items included gender, nationality, US Medical Licensing Examination scores, internal applicants, work and research experience, recommendation letters, residency program, medical school attended, and visa status. Program directors had the ability to list any new characteristics that were not included in the survey. RESULTS: In all, 68 of 72 (94.4%) neuroradiology programs responded to the survey. The most important criteria by which candidates were assessed were (1) residency program attended for educational credential, (2) personality as assessed by faculty at interviews for candidate personal traits, (3) research performed for candidate's extracurricular activities, and (4) likelihood of coming to or previous experience in the fellowship geographic area. Neuroradiology program directors independently stressed residency program attended, personality assessed during the interview by faculty, internal candidate status, letters of recommendation, and research activities as their top five criteria in ranking the candidates. CONCLUSION: Multiple factors are weighed by neuroradiology fellowship program directors in selecting fellows, but recent experiences in residency, research, and faculty interactions are prioritized. Internal candidates have an advantage for remaining as fellows within their residency programs.

Are Women Disadvantaged in Academic Radiology?

RATIONALE AND OBJECTIVES: Women remain underrepresented in leadership positions in radiology. We sought to determine if 1) women are equitably represented in the senior author positions in radiology journals and 2) if women's contributions to the radiology literature and their individual productivity are proportional to their representation at senior academic rank. MATERIALS AND METHODS: The gender of 3,702 first and last authors listed for manuscripts published in nine high-impact American radiology journals was assessed between 2002-2017. For the same years, the gender composition of academic faculty and ranks based on AAMC data was queried. Statistical tests were employed to detect discrepancies and changes over time. RESULTS: First authorship by women grew from 26.9% to 37.4% and from 15.7% to 23.9% as senior author between 2002-2017 (P<.0001). Although the index of manuscript productivity rate was nearly equal for men and women over the 16-year study period, women remained under-represented in senior radiology faculty rank over the same period. CONCLUSIONS: Although women have proportionally increased their contribution to the radiology literature over the years, commensurate increased representation of women in senior authorship and faculty positions was not observed. Despite increased involvement of women in research over time, they remain disproportionately at junior faculty positions.

Underrepresentation of Women on Radiology Editorial Boards.

PURPOSE: Women in radiology are known to be underrepresented in academic leadership positions. We sought to determine if women are appropriately represented on editorial boards and editor-in-chief positions compared with their authorship contributions. MATERIALS AND METHODS: We assessed the first and senior authorship male versus female gender breakdown of manuscripts published in nine high-impact American radiology journals 1 month per year from 2002 to 2017. We looked at the gender of the first authors, senior authors, editorial board members, and editors-in-chief of these journals to see if there was a gender discrepancy. RESULTS: We assessed 3,702 first authors, 3,702 senior authors, and 9,400 editorial board members. Women were underrepresented on the editorial boards compared with their first-authored manuscript contribution in our sample of articles from every journal for every year and were underrepresented compared with their senior-authored manuscript contributions in 119 of 139 (85.6%) journal-years. The percentage of women as first authors (mean = 29.3 ± 9.9), senior authors (mean = 20.7 ± 8.1), and editorial board members (mean = 13.4 ± 6.5) showed major differences (P < .001). This gap did not significantly narrow over the 16 years of study. Notably, there was no woman as editor-in-chief for any of the journal-years. CONCLUSION: There is a gender gap in the composition of editorial boards in radiology compared with authorship contributions by women. Given the implications of editorial board assignment and editorship on women's academic advancement, journals may wish to consider strategies that will narrow the gap.

Lamivudine's efficacy and safety in preventing mother-to-child transmission of hepatitis B: A meta-analysis.

BACKGROUND/AIMS: Mother-to-child transmission (MTCT) is a common transmission mode of hepatitis B virus (HBV). It has been shown that the infection may occur in some infants despite the use of immunoprophylaxis, and many studies have demonstrated the efficacy of antivirals such as lamivudine to reduce such events. MATERIALS AND METHODS: A meta-analysis was conducted concerning the efficacy and safety of lamivudine during pregnancy, in the prevention of vertical transmission of HBV infection. Studies were identified by searching various databases up to January 2016 for variations of the following phrase: "lamivudine AND (pregnancy or pregnant) AND (HBV or hepatitis)." Subjects who had received lamivudine were included in the case group, and those who had not were included in the control group. RESULTS: Our search identified a total number of 881 citations, of which 25 studies (with a total number of 2,667 pregnant women) were included in the meta-analysis. The analysis showed a significant difference between the seropositive HBsAg infants from the case and control groups (RR= 16.97, 95% confidence interval 8.36-34.45), which is the most critical factor in determining the MTCT of HBV. No significant difference was reported between the prevalence of side effects in the case and control groups. CONCLUSION: This meta-analysis strongly suggests the use of lamivudine in the prevention of HBV vertical transmission in carrier pregnant women with the HBV DNA levels greater than 106 copies/mL. And for women with the HBV viral loads lower than 106 copies/mL, we suggest clinicians to examine the use of lamivudine on a case-to-case basis, noting that lamivudine seems to be a safe drug for the mother and the fetus.

The role of the anterior and midcingulate cortex in the neurobiology of functional neurologic disorder.

Functional neurologic disorder (FND)/conversion disorder is a prevalent and disabling condition at the intersection of neurology and psychiatry. Clinicians often report feeling ill-equipped treating patients with FND, perpetuated by a historically limited understanding of neurobiologic disease mechanisms. In this review, we summarize the neuroimaging literature across the spectrum of sensorimotor FND, including functional imaging studies during rest, sensorimotor performance, and emotional-processing tasks as well as structural magnetic resonance imaging findings. Particular attention is given to studies implicating the anterior and middle cingulate cortex and related salience network structures (insula, amygdala, and periaqueductal gray) in the neurobiology of FND. Neuroimaging studies identify cingulo-insular functional alterations during rest, motor performance, and emotion processing in FND populations. The literature also supports that patients with FND exhibit heightened amygdalar and periaqueductal gray reactivity to emotionally valenced stimuli, enhanced coupling between amygdalar and motor control areas, and increased amygdalar volumes. The structural neuroimaging literature also implicates cingulo-insular areas in the pathophysiology of FND, though these findings require replication and clarification. While more research is needed to fully elucidate the pathophysiology of FND, salience network alterations appear present in some FND populations and can be contextualized using biopsychosocial models for FND.

Functional Connectivity in Neurodegenerative Disorders: Alzheimer's Disease and Frontotemporal Dementia.

Neurodegenerative disorders are a growing cause of morbidity and mortality worldwide. Onset is typically insidious and clinical symptoms of behavioral change, memory loss, or cognitive dysfunction may not be evident early in the disease process. Efforts have been made to discover biomarkers that allow for earlier diagnosis of neurodegenerative disorders, to initiate treatment that may slow the course of clinical deterioration. Neuronal dysfunction occurs earlier than clinical symptoms manifest. Thus, assessment of neuronal function using functional brain imaging has been examined as a potential biomarker. While most early studies used task-functional magnetic resonance imaging (fMRI), with the more recent technique of resting-state fMRI, "intrinsic" relationships between brain regions or brain networks have been studied in greater detail in neurodegenerative disorders. In Alzheimer's disease, the most common neurodegenerative disorder, and frontotemporal dementia, another of the common dementias, specific brain networks may be particularly susceptible to dysfunction. In this review, we highlight the major findings of functional connectivity assessed by resting state fMRI in Alzheimer's disease and frontotemporal dementia.

Individual differences in social network size linked to nucleus accumbens and hippocampal volumes in functional neurological disorder: A pilot study.

BACKGROUND: In the biopsychosocial formulation of functional neurological (conversion) disorder (FND), little is known about relationships between social behavior and brain anatomy. We hypothesized that social behavior would relate to brain areas implicated in affiliative behaviors and that social network size would correlate with symptom severity and predisposing vulnerabilities in FND. METHODS: This neuroimaging pilot probed how social network size, as measured by the Social Network Index, related to structural brain profiles in 23 patients with motor FND (15 woman and 8 men). FreeSurfer cortical thickness and subcortical volumetric analyses were performed correcting for multiple comparisons. Stratified analyses compared FND patients with a low social network size to matched healthy controls. Secondary exploratory analyses in an expanded sample of 38 FND patients investigated relationships between social network size, risk factors and patient-reported symptom severity. RESULTS: Adjusting for age and gender, neuroimaging analyses showed that social network size positively correlated with left nucleus accumbens and hippocampal volumes in patients with FND; stratified analyses did not show any group-level differences. In individuals with FND, social network size correlated with health-related quality of life, graduating college, working full-time and a non-epileptic seizure diagnosis; social network size inversely related to lifetime trauma burden, post-traumatic stress disorder severity and age. LIMITATIONS: Only patient-reported scales were used and social network size information was not collected for healthy subjects. CONCLUSIONS: This neuroimaging pilot adds to the literature linking affiliation network brain areas to pro-social behaviors and enhances the biopsychosocial conceptualization of FND.