Rosh Psychiatry Board Practice Exam

Which finding is most likely to be observed on brain MRI of a patient with schizophrenia?

1. Enlarged ventricles

2. Gray matter gain

3. Hyperintense ring-enhancing lesions

4. Mass effect

The correct answer is: Enlarged ventricles

In patients with schizophrenia, neuroimaging studies have consistently demonstrated the presence of structural brain abnormalities. One of the most notable findings on MRI is the enlargement of the ventricles. This enlargement can reflect a loss of surrounding gray matter and is thought to be related to the underlying pathophysiology of the disorder, including neurodevelopmental aspects. The increase in the size of the ventricles is associated with the cognitive dysfunctions and other symptoms commonly observed in schizophrenia. The other options present findings that are less characteristic of schizophrenia. Gray matter gain is not typically associated with schizophrenia, as research has shown that patients often exhibit gray matter loss, particularly in areas crucial for cognitive and emotional functioning. Hyperintense ring-enhancing lesions may suggest infectious or neoplastic processes, which are not related to schizophrenia. Mass effect refers to a displacement of brain structures due to an occupying lesion, which does not align with the typical structural changes observed in schizophrenia. Therefore, the observation of enlarged ventricles is the most consistent and expected finding in MRI studies of individuals with schizophrenia.