QUALITATIVE CEREBRAL MORPHOLOGY IN SCHIZOPHRENIA - A MAGNETIC-RESONANCE-IMAGING STUDY AND SYSTEMATIC LITERATURE-REVIEW

Patients with schizophrenia have larger lateral ventricles, less cereb ral substance and smaller mesial temporal lobe structures than groups of normal controls, but it has proved difficult to link these volumetr ic abnormalities with clinical features of the illness. Such quantitat ive techniques may overlook qualitative abnormalities of importance. W e therefore compared a neuroradiologists' clinical assessment of gross structural abnormalities, generalised 'atrophy' and high intensity si gnal (HIS) foci, as detected on the first and second echo of a long TR sequence, in 42 patients with schizophrenia (22 treatment responsive, 20 treatment resistant) and 50 normal controls. The schizophrenic gro up included two (5%) subjects with gross lesions, two (5%) with cerebe llar atrophy, 21 (52%) with at least a mild degree of cerebral atrophy , and 15 (38%) with one or more HIS foci; the comparable figures in th e controls being 2, 0, 2 and 14%, respectively. Controlling for age, p atients with schizophrenia had a substantially elevated rate of cerebr al atrophy (odds ratio (OR)=11.7, p<0.0001). Treatment-resistant schiz ophrenics showed a tendency (OR=2.8, p=0.06) to greater atrophy than t hose who were treatment responsive, whereas our previous volumetric st udy showed no such difference. In contrast, the presence of HIS foci w as only related to age. The degree of atrophy was correlated with the number of HIS foci (r=0.31, p=0.014). Taken together with previous stu dies, these findings demonstrate the value of qualitative examination of MRI images in patients with schizophrenia. (C) 1997 Elsevier Scienc e B.V.