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Am J Psychiatry 1992; 149:784-794
Copyright © 1992 by American Psychiatric Association
Qualitative assessment of brain morphology in acute and chronic schizophrenia
J Lieberman, B Bogerts, G Degreef, M Ashtari, G Lantos and J Alvir
Department of Psychiatry, Long Island Jewish Medical Center, Albert Einstein College of Medicine, Glen Oaks, NY 11004.
OBJECTIVE: Neuroimaging studies of brain morphology in schizophrenia have
used predominantly morphometric techniques to assess brain scans. However,
as currently implemented, such methods are not particularly helpful in the
routine assessment of individual patients. The purpose of this study was to
evaluate brain morphology seen with magnetic resonance imaging (MRI) by
qualitative assessment, the most frequently used method in clinical
practice for evaluating brain scans. METHOD: First-episode (N = 62) and
chronic, multi-episode (N = 24) schizophrenic patients and healthy
comparison subjects (N = 42) underwent MRI of the whole head in a sequence
that provided 63 contiguous brain slice images. Each subject received a
rating of normal, questionably abnormal, or definitely abnormal for four
brain regions (lateral ventricles, third ventricle, medial temporal lobe
structures, and frontal/parietal cortex) and a global rating. RESULTS: The
schizophrenic patients had significantly higher global rates of abnormal
morphology (first-episode group, 31%; chronic group, 42%) than the normal
subjects (5%). The highest regional rates of abnormalities were seen in the
lateral ventricles and the lowest in the frontal/parietal cortex. Although
the chronic patients had generally higher abnormal rates than the
first-episode patients, these differences were not statistically
significant. The qualitative ratings of brain morphology were significantly
correlated with quantitative assessments performed in separate studies.
CONCLUSIONS: Despite its limits in sensitivity (and until quantitative
morphometric techniques are made practical and more widely available),
qualitative evaluation of MRI scans can be a useful technique in research
and clinical evaluation of patients with schizophrenia.
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