ReviewDiffusion Tensor Imaging in Schizophrenia
Section snippets
Methods and Materials
Our inclusion criteria were that studies be published in peer-reviewed journals and make anisotropy-based statistical comparisons between schizophrenia patients and control subjects. Letters and abstracts were excluded. Online searches of the databases EMBASE, PubMed, PsychInfo, and Medline were performed, using the search terms schizophrenia, psychosis, diffusion, tensor, DTI, and MRI. An additional manual search was performed on the 2004 issues of those psychiatric and neuroimaging journals
Results
There has been a remarkable proliferation of studies using DTI in schizophrenia. After the first in 1998, there followed one in 1999 and 2000, growing to eight studies in 2003 alone. A total of 19 studies met the inclusion criteria (see Table 1). Four other studies correlated FA values with impulsivity (Hoptman et al 2002, Hoptman et al 2004), negative symptoms (Wolkin et al 2003), and neuropsychological measures (Nestor et al 2004) but did not compare FA with control subjects. One further
Voxel-Based Studies
Overall, though 14 studies found reduced FA in patients with schizophrenia, there was a lack of consistent findings. The variation in the regions examined limits direct comparison in most cases, so we shall focus on the two tracts which have been most studied: the corpus callosum and the cingulum. First, we shall compare the voxel-based studies, which perforce include every region examined by the ROI studies. Foong et al (2002) found no significant differences in their sample of 14 patients,
Discussion
Most DTI studies in schizophrenia found some positive results, though there were many negative results; indeed, for any region where studies found a positive result, at least as many failed to find one. While it is thus possible that there are no real differences in FA between patients with schizophrenia and control subjects, it is also possible that there are real but small (or highly variable) differences but at least some of the studies did not have enough power to detect them (type 2
Conclusion
Diffusion tensor imaging has yet to detect reproducibly consistent FA differences in schizophrenia, although varied methodology prevented direct comparison between most studies. As we are seeking subtle differences that may be relatively small when compared with the variance in current methods, forthcoming studies with larger, more homogenous samples may yet realize the true potential of DTI.
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