Magnetic resonance imaging for early detection and studies of schizophrenia – state of the art

Schizophrenia is a complex and severe mental disorder and is characterised by a heterogeneous set of different symptoms. Although the current diagnosis of schizophrenia is still based on clinical assessments and operationalised symptom criteria, magnetic resonance imaging (MRI) assessments are important for the differential diagnosis of brain pathologies and potential organic causes of psychosis. In schizophrenia research, MRI and other neuroimaging techniques are already indispensable and of utmost relevance to a better understanding of disrupted brain networks and neurotransmitter systems, as well as neuroanatomical signatures related to schizophrenia. This article aims to bridge the gap between the current clinical utility of MRI and recent advances from MRI research in identifying neural substrates related to the development and treatment of schizophrenia. We first describe the current evidence and recommendations for the clinical utility of structural MRI in the diagnostic workup of patients with psychotic symptoms. The second part of this article provides a brief overview of how recent functional MRI research extends our knowledge of dopamine and reward system dysfunction in schizophrenia over the last years. Collectively, these studies provide growing evidence that basic principles of information processing such as salience evaluation and context-dependent efficient neural adaptation are disrupted across different stages of the schizophrenia spectrum and may be fundamental underlying neural mechanisms in the development of psychosis. These findings are an important contribution to understanding the neural basis of schizophrenia, but they cannot yet be translated into individualised treatment. Future work should therefore capitalise on the manifold potential of multimodal MRI to further the development of MRI applications for diagnostics and individualised treatment in schizophrenia.