Rivierduinen, Langevelderweg 27, 2211 AB Noordwijkerhout, The Netherlands.
J Psychiatr Res. 2010 Nov;44(15):993-1004. doi: 10.1016/j.jpsychires.2010.05.003. Epub 2010 Jun 15.
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.
连接异常模型表明，神经通讯的整合障碍是精神分裂症的核心。大脑宏观结构回路的完整性可以通过弥散张量成像（DTI）来检查，这是一种对大脑白质微观结构异常敏感的 MRI 应用。对首发精神分裂症患者和精神病高危个体的 DTI 研究可以深入了解结构连接异常在精神病易感性、发病和早期病程中的作用。这篇综述讨论了：（i）脑白质异常在精神分裂症中的作用观点，（ii）DTI 及其在精神分裂症中的应用，（iii）首发患者和精神病高危个体的 DTI 研究结果；它们的时间、解剖位置和早期病程，（iv）假设的潜在病理基础和 DTI 脑白质改变的可能原因，包括青少年使用大麻的影响，以及（v）一些方法学问题和未来建议。总之，有证据表明 DTI 异常与精神病易感性有关，并且在精神病发病前后还会出现其他异常。然而，首发患者的发现不如慢性患者那么可靠，并且在预后不良患者的早期病程中可能会出现进展性紊乱。此外，正常衰老过程可能会加速。青少年使用大麻对 DTI 测量有特定影响。尚未解决的问题是 DTI 异常的潜在病理学，将 DTI 与其他 MRI 指标相结合可以提供更多的见解。需要更多的研究来确定哪些遗传和环境因素在当前结果的变异性中起作用。
