Cortical Iron in Schizophrenia: A Quantitative Susceptibility Mapping and Diffusion Tensor Imaging MRI Study

Background and HypothesisCognitive and negative symptoms in schizophrenia remain poorly treated. Iron dysregulation has been implicated as a potential mechanism underlying cognitive dysfunction and schizophrenia. While elevated postmortem iron in Brodmann areas 10-11 has been linked to schizophrenia, this has not been assessed in vivo. We therefore used iron-sensitive MRI to test whether cortical iron is elevated in individuals with schizophrenia compared to healthy controls. Study DesignWe acquired quantitative susceptibility mapping (QSM) MRI to measure magnetic susceptibility ({chi}), a marker of iron, in 158 participants aged 18-45 (73 with schizophrenia and 76 matched healthy controls). As {chi} is reduced by myelin, we conducted diffusion tensor imaging (DTI) to assess mean diffusivity, an iron-insensitive marker also reduced by myelin. Study ResultsPrimary analyses showed no significant case-control differences in {chi} in the whole cortex (p=0.675) or Brodmann areas 10-11 (p=0.537). Exploratory analyses examined {chi} for 362 cortical regions and a voxelwise analysis, correcting for multiple comparisons. Two left temporo-parieto-occipital (TPO) junction regions showed significantly elevated {chi} in schizophrenia: the posterior TPO junction (d=0.752, p<0.001) and the superior temporal visual area (d=0.638, p=0.033), which remained significant after adjusting for mean diffusivity and clinical covariates (p=0.001 and p=0.023, respectively). Voxelwise analysis confirmed elevated {chi} in schizophrenia in the left TPO junction (peak t=5.62). ConclusionsThis study provides the first in vivo evidence of elevated cortical iron in schizophrenia, suggesting regional iron accumulation may contribute to cortical pathology.