Why do you think your paper is highly cited?

Our paper is likely highly cited because it reviews an important time period in the history of schizophrenia research. In this paper we review magnetic resonance imaging (MRI) findings in schizophrenia over a twelve-year time span (1988 to 2000). This time span has witnessed a burgeoning of MRI studies of schizophrenia and has led to more definitive findings of brain abnormalities than any other time period in the history of schizophrenia research. Such progress in defining the neuropathology of schizophrenia is largely due to advances in in vivo neuroimaging techniques; advances that have made it possible to investigate heretofore immeasurable brain abnormalities. Thus our review of the field is timely as it summarizes a large body of data that has accumulated over a relatively short period of time.

As a review article, the emphasis is on summarizing MRI findings in schizophrenia and in suggesting new avenues for future research. We also highlight the advent of important neuroimaging techniques that made it possible to confirm brain abnormalities in schizophrenia.

What is most fascinating about this area of research is that there have long been speculations concerning brain abnormalities in schizophrenia. Early investigations, however, were hampered by crude measurement tools, and post-mortem studies were disappointing because of conflicting findings. Research interest thus waned and did not flourish again until 1976, following a pivotal computer assisted tomography finding of enlarged lateral ventricles in schizophrenia. The first MRI study of schizophrenia was in 1984. Since 1984, the resolution of MR imaging has greatly improved and major advances in technology have led to the identification of a number of brain abnormalities in schizophrenia, with the most robust findings being ventricular enlargement and a preferential involvement of medial temporal lobe structures including the amygdala, hippocampus, and parahippocampal gyrus and neocortical temporal lobe structures, most particularly the superior temporal gyrus. There has also been moderate evidence for frontal and parietal lobe involvement in schizophrenia as well as evidence for subcortical abnormalities (i.e., cavum septi pellucidi, basal ganglia, corpus callosum, and thalamus), with more equivocal evidence for cerebellar abnormalities. Importantly, as several different brain regions are involved in the neuropathology of schizophrenia, new models need to be developed and tested that explain neural circuitry abnormalities that effect brain regions that are not necessarily structurally proximal but are nonetheless functionally related. With still newer advances in neuroimaging such as diffusion tensor imaging to investigate brain connectivity and white matter fiber tracts, as well as methods to analyze brain function (i.e., fMRI) and structural simultaneously, we are now able to understand more fully the neuropathology of schizophrenia.

The significance of the paper is that it provides a comprehensive review of MRI findings in schizophrenia. It covers a twelve-year period, which has been critical to our understanding of brain abnormalities in schizophrenia.

Martha E. Shenton, Ph.D.
Professor of Psychology
Department of Psychiatry
Boston VA Healthcare System, Brockton Division,
And Harvard Medical School