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A Longitudinal Magnetic Resonance Imaging Study

Kiyoto Kasai, MD; Martha E. Shenton, PhD; Dean F. Salisbury, PhD; Yoshio Hirayasu, MD, PhD; Toshiaki Onitsuka, MD, PhD; Magdalena H. Spencer, BS; Deborah A. Yurgelun-Todd, PhD; Ron Kikinis, MD; Ferenc A. Jolesz, MD; Robert W. McCarley, MD

Arch Gen Psychiatry. 2003;60:766-775.

Background  The Heschl gyrus and planum temporale have crucial roles in auditory perception and language processing. Our previous investigation using magnetic resonance imaging (MRI) indicated smaller gray matter volumes bilaterally in the Heschl gyrus and in left planum temporale in patients with first-episode schizophrenia but not in patients with first-episode affective psychosis. We sought to determine whether there are progressive decreases in anatomically defined MRI gray matter volumes of the Heschl gyrus and planum temporale in patients with first-episode schizophrenia and also in patients with first-episode affective psychosis.

Methods  At a private psychiatric hospital, we conducted a prospective high spatial resolution MRI study that included initial scans of 28 patients at their first hospitalization (13 with schizophrenia and 15 with affective psychosis, 13 of whom had a manic psychosis) and 22 healthy control subjects. Follow-up scans occurred, on average, 1.5 years after the initial scan.

Results  Patients with first-episode schizophrenia showed significant decreases in gray matter volume over time in the left Heschl gyrus (6.9%) and left planum temporale (7.2%) compared with patients with first-episode affective psychosis or control subjects.

Conclusions  These findings demonstrate a left-biased progressive volume reduction in the Heschl gyrus and planum temporale gray matter in patients with first-episode schizophrenia in contrast to patients with first-episode affective psychosis and control subjects. Schizophrenia but not affective psychosis seems to be characterized by a postonset progression of neocortical gray matter volume loss in the left superior temporal gyrus and thus may not be developmentally fixed.

From the Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, Mass, and Harvard Medical School, Boston, Mass (Drs Kasai, Shenton, Salisbury, Onitsuka, and McCarley and Ms Spencer); Surgical Planning Laboratory, Magnetic Resonance Imaging Division, Brigham and Women's Hospital, and Department of Radiology, Harvard Medical School, Boston (Drs Shenton, Kikinis, and Jolesz); Cognitive Neuroscience Laboratory (Dr Salisbury) and Brain Imaging Center (Dr Yurgelun-Todd), McLean Hospital, Belmont, Mass; and Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan (Dr Hirayasu).

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