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Raquel E. Gur, MD, PhD; Patricia E. Cowell, PhD; Amanda Latshaw, BS; Bruce I. Turetsky, MD; Robert I. Grossman, MD; Steven E. Arnold, MD; Warren B. Bilker, PhD; Ruben C. Gur, PhD

Arch Gen Psychiatry. 2000;57:761-768.

Background  Converging neuroanatomic, neurophysiological, and neurobehavioral evidence implicate prefrontal subregions in schizophrenia. Neuroanatomic studies with magnetic resonance (MR) imaging enable regional volume parcellation. Inconsistent reports may relate to variable methods and small samples. We attempted to resolve volume differences within sectors of the prefrontal lobe in a large sample, relating volumes to clinical and neurocognitive features.

Methods  Magnetic resonance imaging was performed in 70 patients with schizophrenia (40 men and 30 women; 29 neuroleptic naive and 41 previously treated) and 81 healthy controls (34 men and 47 women). Gray and white matter volumes of the dorsolateral, dorsomedial, orbitolateral, and orbitomedial prefrontal cortex were quantified. Symptoms, functioning, and neurocognition were assessed concurrently.

Results  Reduced prefrontal gray matter volume was observed in patients. The reduction was evident for the dorsolateral area in men (9%) and women (11%), for the dorsomedial area only in men (9%), and for orbital regions only in women (23% and 10% for lateral and medial, respectively). The reduction of orbital volume in women was associated with poorer premorbid functioning, more severe negative symptoms, and depression. Volume of dorsal cortex was positively associated with better performance on abstraction and attention tasks across all groups.

Conclusions  Schizophrenia is associated with reduced gray matter volume in prefrontal cortex, which affects men and women in the dorsolateral sector. The effects are moderated by sex for dorsomedial and orbital regions and are related to symptom severity and cognitive function. This is not a by-product of treatment, since the differences are evident in neuroleptic-naive patients.

From the Schizophrenia Research Center, Neuropsychiatry Section, Department of Psychiatry (Drs R. E. Gur, Cowell, Turetsky, Grossman, Arnold, Bilker, and R. C. Gur and Ms Latshaw) and the Departments of Radiology (Dr Grossman) and Biostatistics and Epidemiology (Dr Bilker), University of Pennsylvania School of Medicine, Philadelphia.

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