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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精神分裂症中的功能磁共振成像：当前证据、方法学进展、局限性和未来方向


功能神经影像学的出现前景广阔，并为精神分裂症的神经生物学提供了基本见解。然而，它面临着挑战和批评，最明显的是缺乏临床转化。本文对精神分裂症中功能性神经影像学，特别是功能性磁共振成像 （fMRI） 的文献进行了全面回顾和批判性总结。我们首先通过历史视角回顾了精神分裂症和临床高风险阶段的 fMRI 生物标志物的研究，从病例对照区域脑激活转向全球连接和先进的分析方法，以及最近的机器学习算法来识别预测性神经影像学特征。然后回顾阴性症状以及神经认知和社会认知缺陷的 fMRI 研究结果。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的有前途的治疗靶点。接下来，我们总结了与抗精神病药物、心理治疗和社会心理干预以及神经刺激相关的 fMRI 研究，包括治疗反应和耐药、治疗机制和治疗靶向。我们还回顾了 fMRI 和数据驱动方法剖析精神分裂症异质性的效用，超越了病例对照比较，以及方法学考虑和进步，包括联盟和精确 fMRI。最后，讨论了该领域研究的局限性和未来方向。 我们的综合综述表明，为了使功能磁共振成像在临床上对精神分裂症患者的护理有用，研究应解决精神分裂症治疗中常规的潜在可操作临床决策，例如应该开哪种抗精神病药或给定患者是否可能患有持续功能障碍。fMRI 的潜在临床效用受成本和可及性因素的影响，必须权衡成本因素。未来对 fMRI 在预后和治疗反应研究中效用的评估可以考虑包括卫生经济学分析。