McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada.
Concordia University, Montreal, QC, Canada; Montreal Heart Institute, Montreal, QC, Canada.
Prog Neuropsychopharmacol Biol Psychiatry. 2023 Mar 8;121:110669. doi: 10.1016/j.pnpbp.2022.110669. Epub 2022 Oct 28.
Schizophrenia-spectrum disorders (SSD) represent one of the leading causes of disability worldwide and are usually underpinned by neurodevelopmental brain abnormalities observed on a structural and functional level. Nuclear medicine imaging studies of cerebral blood flow (CBF) have already provided insights into the pathophysiology of these disorders. Recent developments in non-invasive MRI techniques such as arterial spin labeling (ASL) have allowed broader examination of CBF across SSD prompting us to conduct an updated literature review of MRI-based perfusion studies. In addition, we conducted a focused meta-analysis of whole brain studies to provide a complete picture of the literature on the topic.
A systematic OVID search was performed in Embase, MEDLINEOvid, and PsycINFO. Studies eligible for inclusion in the review involved: 1) individuals with SSD, first-episode psychosis or clinical-high risk for psychosis, or; 2) had healthy controls for comparison; 3) involved MRI-based perfusion imaging methods; and 4) reported CBF findings. No time span was specified for the database queries (last search: 08/2022). Information related to participants, MRI techniques, CBF analyses, and results were systematically extracted. Whole-brain studies were then selected for the meta-analysis procedure. The methodological quality of each included studies was assessed.
For the systematic review, the initial Ovid search yielded 648 publications of which 42 articles were included, representing 3480 SSD patients and controls. The most consistent finding was that negative symptoms were linked to cortical fronto-limbic hypoperfusion while positive symptoms seemed to be associated with hyperperfusion, notably in subcortical structures. The meta-analysis integrated results from 13 whole-brain studies, across 426 patients and 401 controls, and confirmed the robustness of the hypoperfusion in the left superior and middle frontal gyri and right middle occipital gyrus while hyperperfusion was found in the left putamen.
This updated review of the literature supports the implication of hemodynamic correlates in the pathophysiology of psychosis symptoms and disorders. A more systematic exploration of brain perfusion could complete the search of a multimodal biomarker of SSD.
精神分裂症谱系障碍（SSD）是全球导致残疾的主要原因之一，通常以结构和功能水平上观察到的神经发育性大脑异常为基础。脑血流（CBF）的核医学成像研究已经为这些疾病的病理生理学提供了深入的了解。最近，动脉自旋标记（ASL）等无创 MRI 技术的发展使得对 SSD 患者的 CBF 进行更广泛的检查成为可能，促使我们对基于 MRI 的灌注研究进行了更新的文献综述。此外，我们还对全脑研究进行了重点荟萃分析，以提供该主题文献的全貌。
在 Embase、MEDLINE Ovid 和 PsycINFO 中进行了系统的 OVID 搜索。符合纳入标准的研究包括：1）患有 SSD、首发精神病或精神病高危的个体，或；2）有健康对照进行比较；3）涉及 MRI 灌注成像方法；4）报告 CBF 结果。未指定数据库查询的时间范围（最后一次搜索：2022 年 8 月）。系统地提取了与参与者、MRI 技术、CBF 分析和结果相关的信息。然后选择全脑研究进行荟萃分析程序。评估了每个纳入研究的方法学质量。
对于系统评价，初步 Ovid 搜索产生了 648 篇出版物，其中 42 篇文章被纳入，代表了 3480 名 SSD 患者和对照。最一致的发现是，阴性症状与皮质额-边缘区灌注不足有关，而阳性症状似乎与灌注过度有关，特别是在皮质下结构中。荟萃分析整合了 13 项全脑研究的结果，涉及 426 名患者和 401 名对照，证实了左额上回和中回以及右中枕回灌注不足的稳健性，而左壳核则存在灌注过度。
对文献的更新综述支持了血流动力学相关性在精神病症状和障碍病理生理学中的作用。更系统地探索脑灌注可以完善 SSD 的多模态生物标志物的研究。
