Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2016; 8(2): 210-225
Published online Feb 28, 2016. doi: 10.4329/wjr.v8.i2.210
Functional magnetic resonance imaging of internet addiction in young adults
Gianna Sepede, Margherita Tavino, Rita Santacroce, Federica Fiori, Rosa Maria Salerno, Massimo Di Giannantonio
Gianna Sepede, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University “A. Moro”, 70121 Bari, Italy
Gianna Sepede, Margherita Tavino, Rita Santacroce, Federica Fiori, Rosa Maria Salerno, Massimo Di Giannantonio, Department of Neuroscience, Imaging, and Clinical Sciences, University “G.d’Annunzio”, 66100 Chieti, Italy
Author contributions: Sepede G, Salerno RM and Di Giannantonio M designed the research; Sepede G, Tavino M, Santacroce R and Fiori F performed the PubMed research, selected the papers included in the qualitative review and summarized the results; Sepede G, Salerno RM and Di Giannantonio M wrote the paper; Santacroce R performed the language editing.
Supported by Department of Neuroscience, Imaging, and Clinical Sciences, University “G.d’Annunzio”, Chieti, Italy; Dr. Sepede’s post hoc grant has been funded by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement, No. 602450.
Conflict-of-interest statement: All authors do not report any conflict of interest. This paper reflects only the authors’ views and the European Union is not liable for any use that may be made of the information contained therein.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Gianna Sepede, MD, PhD, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University “A. Moro”, Piazza G. Cesare, 11, 70121 Bari, Italy.
Telephone: +39-0871-3556901 Fax: +39-0871-3556930
Received: July 27, 2015
Peer-review started: July 30, 2015
First decision: October 30, 2015
Revised: December 4, 2015
Accepted: December 18, 2015
Article in press: December 21, 2015
Published online: February 28, 2016

AIM: To report the results of functional magnetic resonance imaging (fMRI) studies pertaining internet addiction disorder (IAD) in young adults.

METHODS: We conducted a systematic review on PubMed, focusing our attention on fMRI studies involving adult IAD patients, free from any comorbid psychiatric condition. The following search words were used, both alone and in combination: fMRI, internet addiction, internet dependence, functional neuroimaging. The search was conducted on April 20th, 2015 and yielded 58 records. Inclusion criteria were the following: Articles written in English, patients’ age ≥ 18 years, patients affected by IAD, studies providing fMRI results during resting state or cognitive/emotional paradigms. Structural MRI studies, functional imaging techniques other than fMRI, studies involving adolescents, patients with comorbid psychiatric, neurological or medical conditions were excluded. By reading titles and abstracts, we excluded 30 records. By reading the full texts of the 28 remaining articles, we identified 18 papers meeting our inclusion criteria and therefore included in the qualitative synthesis.

RESULTS: We found 18 studies fulfilling our inclusion criteria, 17 of them conducted in Asia, and including a total number of 666 tested subjects. The included studies reported data acquired during resting state or different paradigms, such as cue-reactivity, guessing or cognitive control tasks. The enrolled patients were usually males (95.4%) and very young (21-25 years). The most represented IAD subtype, reported in more than 85% of patients, was the internet gaming disorder, or videogame addiction. In the resting state studies, the more relevant abnormalities were localized in the superior temporal gyrus, limbic, medial frontal and parietal regions. When analyzing the task related fmri studies, we found that less than half of the papers reported behavioral differences between patients and normal controls, but all of them found significant differences in cortical and subcortical brain regions involved in cognitive control and reward processing: Orbitofrontal cortex, insula, anterior and posterior cingulate cortex, temporal and parietal regions, brain stem and caudate nucleus.

CONCLUSION: IAD may seriously affect young adults’ brain functions. It needs to be studied more in depth to provide a clear diagnosis and an adequate treatment.

Keywords: Internet addiction, Pathologic internet use, Functional magnetic resonance imaging, Internet gaming disorder, Functional neuroimaging

Core tip: We systematically reviewed the functional magnetic resonance imaging studies on adults affected by internet addiction disorder (IAD), without any other psychiatric condition. We found 18 studies, mostly conducted in East Asia and enrolling young males with internet gaming disorder. Internet addicts showed functional alterations in regions involved in cognitive control and reward/punishment sensitivity (orbitofrontal cortex, anterior and posterior cingulate, insula, dorsolateral prefrontal cortex, temporoparietal regions, brain stem and caudate nucleus) that are similar to those observed in substance use disorder. IAD is a disabling condition needing careful consideration due to its severe impact on young people’s brain functioning.