Researchers of a recent systematic review evaluated 56 longitudinal studies using positron emission tomography and single photon emission computed tomography imaging in schizophrenia-spectrum disorders (SSD), analyzing over 1,300 patients. The most frequently studied systems involved dopamine synthesis and receptor availability, with tracers like [¹⁸F]FDOPA and [¹¹C]raclopride offering strong predictive value for psychosis conversion, treatment response, and side-effect management. Although imaging has clarified pathophysiological mechanisms—such as presynaptic dopamine overactivity—it remains underutilized in clinical settings, partly due to variability in study design, imaging protocols, and reporting.

Molecular imaging holds strong promise for personalizing care in SSD, particularly in identifying treatment-resistant patients and optimizing antipsychotic dosing. Evidence also points to emerging imaging targets like neuroinflammation, synaptic density, and glutamatergic activity, which could offer insights into negative symptoms and cognitive deficits. However, standardization, cost, and accessibility remain key challenges. A shift toward shorter scan protocols, use of long half-life tracers, and randomized clinical trials will be essential to transition these tools from research to routine care. Ultimately, integrating molecular imaging could help guide earlier interventions, improve outcomes, and reduce the burden of illness across the schizophrenia spectrum.

Reference: Rogeau A, Boer AJ, Guedj E, et al. EANM perspective on clinical PET and SPECT imaging in schizophrenia-spectrum disorders: a systematic review of longitudinal studies. Eur J Nucl Med Mol Imaging. 2025;52(3):876-899. doi: 10.1007/s00259-024-06987-1.