Diffusion tensor imaging in the early phase of schizophrenia: what have we learned?

The dysconnectivity model suggests that disturbed integration of neural communication is central to schizophrenia. The integrity of macro-structural brain circuits can be examined with diffusion tensor imaging (DTI), an MRI application sensitive to microstructural abnormalities of brain white matter. DTI studies in first-episode schizophrenia patients and individuals at high-risk of psychosis can provide insight into the role of structural dysconnectivity in the liability, onset and early course of psychosis. This review discusses (i) views on the role of white matter abnormalities in schizophrenia, (ii) DTI and its application in schizophrenia, (iii) DTI findings in first-episode patients and subjects at high-risk of psychosis; their timing, anatomical location and early course, (iv) the hypothesized underlying pathological substrate and possible causes of DTI white matter alterations, including effects of adolescent cannabis use, and (v) some methodological issues and future recommendations. In summary, there is evidence that DTI abnormalities convey a liability for psychosis and additional abnormalities occur around onset of psychosis. However, findings in first-episode patients are less robust than in chronic patients, and progression of disturbances may occur in the early course of poor-outcome patients. In addition, acceleration of the normal aging process may occur. Adolescent cannabis use has specific effects on DTI measures. An unresolved issue is the underlying pathology of DTI abnormalities, and combining DTI with other MRI indices can provide more insight. More research is needed on which genetic and environmental factors play a role in the variability of current results.