Functional neuroimaging emerged with great promise and has provided fundamental insights into the neurobiology of schizophrenia. However, it has faced challenges and criticisms, most notably a lack of clinical translation. This paper provides a comprehensive review and critical summary of the literature on functional neuroimaging, in particular functional magnetic resonance imaging (fMRI), in schizophrenia. We begin by reviewing research on fMRI biomarkers in schizophrenia and the clinical high risk phase through a historical lens, moving from case-control regional brain activation to global connectivity and advanced analytical approaches, and more recent machine learning algorithms to identify predictive neuroimaging features. Findings from fMRI studies of negative symptoms as well as of neurocognitive and social cognitive deficits are then reviewed. Functional neural markers of these symptoms and deficits may represent promising treatment targets in schizophrenia. Next, we summarize fMRI research related to antipsychotic medication, psychotherapy and psychosocial interventions, and neurostimulation, including treatment response and resistance, therapeutic mechanisms, and treatment targeting. We also review the utility of fMRI and data-driven approaches to dissect the heterogeneity of schizophrenia, moving beyond case-control comparisons, as well as methodological considerations and advances, including consortia and precision fMRI. Lastly, limitations and future directions of research in the field are discussed. Our comprehensive review suggests that, in order for fMRI to be clinically useful in the care of patients with schizophrenia, research should address potentially actionable clinical decisions that are routine in schizophrenia treatment, such as which antipsychotic should be prescribed or whether a given patient is likely to have persistent functional impairment. The potential clinical utility of fMRI is influenced by and must be weighed against cost and accessibility factors. Future evaluations of the utility of fMRI in prognostic and treatment response studies may consider including a health economics analysis.

中文翻译：

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精神分裂症的功能磁共振成像：当前证据、方法学进展、局限性和未来方向


功能性神经影像学的出现带来了巨大的希望，并为精神分裂症的神经生物学提供了基本的见解。然而，它面临着挑战和批评，最明显的是缺乏临床转化。本文对精神分裂症的功能神经影像学，特别是功能磁共振成像（fMRI）的文献进行了全面的回顾和批判性总结。我们首先通过历史视角回顾精神分裂症和临床高风险阶段的功能磁共振成像生物标志物的研究，从病例对照区域大脑激活转向全局连接和先进的分析方法，以及识别预测神经影像特征的最新机器学习算法。然后对阴性症状以及神经认知和社会认知缺陷的功能磁共振成像研究结果进行审查。这些症状和缺陷的功能性神经标志物可能代表精神分裂症有希望的治疗目标。接下来，我们总结了与抗精神病药物、心理治疗和心理社会干预以及神经刺激相关的功能磁共振成像研究，包括治疗反应和抵抗、治疗机制和治疗靶向。我们还回顾了功能磁共振成像和数据驱动方法在剖析精神分裂症异质性方面的实用性，超越了病例对照比较，以及方法论考虑和进展，包括联合和精确功能磁共振成像。最后，讨论了该领域研究的局限性和未来方向。 我们的全面审查表明，为了使功能磁共振成像在精神分裂症患者的护理中发挥临床作用，研究应解决精神分裂症治疗中常规的潜在可行的临床决策，例如应开出哪种抗精神病药物或特定患者是否可能患有精神分裂症。存在持续的功能障碍。 fMRI 的潜在临床效用受到成本和可及性因素的影响，并且必须权衡这些因素。未来对功能磁共振成像在预后和治疗反应研究中的效用的评估可能会考虑包括健康经济学分析。