Schizophrenia is a severe disorder with a lifetime prevalence of approximately 1%. The underlying pathophysiology is unknown. There are currently no «objective» measurable criteria for diagnosing schizophrenia, but it is common to include radiological examinations such as computerised tomography (CT) or magnetic resonance imaging (MRI) of the head, primarily to exclude cerebral somatic causes of psychotic symptoms and changed behaviour. But can MR imaging of patients with schizophrenia tell us anything more than the presence orabsence of organic brain pathology? Can ever more sophisticated MRI post-processing tools and ultrahigh resolution MR images increase our knowledge of the pathophysiological mechanisms related to the disorder? Can MR images be used to distinguish between healthy and sick individuals?
The first in vivo brain scans of patients with schizophrenia were performed with pneumoencephalography (scanning of the ventricles) as early as 1927 (1). This was a painful procedure in which air was injected into the cerebrospinal canal, and one potential side effect was headache that could last for months (2). CT head scans, which came into use in schizophrenia research towards the end of the 1970s, were painless but exposed patients to large doses of radiation (3). The MR imaging procedures we use today are painless, do not expose patients to radiation and have no other side effects. This has made it possible to use repeated MRI scans to examine for research purposes large groups of patients and healthy control subjects. The number of scientific studies in which MR imaging has been used to examine anatomical changes occurring in schizophrenia has increased substantially inrecent years. We will review this literature in the following.
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