Enlarged brain perivascular spaces in chronic schizophrenia but not in first-episode psychosis: a cross-sectional study

Enlarged perivascular spaces (EPVS) are MRI-visible markers associated with glymphatic system function and brain waste clearance, and are thought to reflect neurovascular, neuroinflammatory, and age-related changes. While schizophrenia is associated with neuroinflammation and accelerated brain aging, little is known about metabolic brain waste clearance in the condition. Moreover, whether EPVS burden differs across stages of disease is unclear.

This study aimed to compare EPVS in the centrum semiovale (CSO) and basal ganglia (BG) among individuals with schizophrenia, first-episode psychosis (FEP), and healthy controls, with a total of 174 subjects included. EPVS were quantified using high-resolution 3T MRI and a standardized rating scale, with assessments conducted by three independent raters. Ordinal logistic regression showed higher odds of being in a higher CSO-EPVS category in chronic schizophrenia versus healthy controls (OR 2.31, 95% CI 1.15–4.62, p = 0.02), as well as higher total EPVS burden (OR 2.02, 95% CI 1.04–3.93, p = 0.04), while no significant group differences were observed for BG-EPVS or between FEP and healthy controls.

These findings suggest regional and group-specific differences in EPVS burden, with greater burden in chronic schizophrenia primarily reflected by CSO-EPVS rather than BG-EPVS. This study emphasizes the potential role of neurovascular and neuroinflammatory processes in schizophrenia, aligning with evidence of accelerated brain aging in the disorder. EPVS-Basal Ganglia Enlarged Perivascular Spaces EPVS-Centum Semiovale Enlarged Perivascular Spaces 10-International Classification of Diseases, 10th Revision Magnetization-Prepared Rapid Gradient-Echo MRI Sequence Supported by the Ministry of Health of the Czech Republic, grant nr.

NU22-04-00143 and by project nr. LX22NPPO5107 (MEYS): Financed by European Union-Next Generation EU. Department of Anatomy, Third Faculty of Medicine, Charles University, Ruska 87, Prague, 100 00, Czech Republic National Institute of Mental Health, Klecany, Czech Republic Alexandra Morozova, Petr Zach, Antonin Škoch, Yuliya Zaytseva & Filip Španiel Third Faculty of Medicine, Charles University, Prague, Czech Republic Katharina Geier, Georgia Piyioti, Nikol Pasik, Yousef Kehail, Marie Chudožilov Bendová, Yuliya Zaytseva & Filip Španiel Department of Psychiatry and Psychotherapeutic Medicine, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany Department of Statistical Modeling, Institute of Computer Science, Academy of Sciences of the Czech Republic, Prague, Czech Republic Department of Neurology, Karolinska University Hospital, Stockholm, Sweden Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel Krembil Brain Institute, University Health Network, Toronto, Ontatrio, Canada The authors declare no competing interests.

The project was approved by the Ethical Committee of the NIMH and was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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