Evaluation of CSF flow dynamics in patients with schizophrenia using phase-contrast cine MRI

•In patients with schizophrenia, CSF flow through the aqueduct channel from the third ventricle to the fourth ventricle showed a lower peak velocity, a lower net forward volume and a lower average flow over the range studied.•The aqueduct area of males schizophrenic patients was significantly larger than that of female patients.•The average velocity in schizophrenia patients with a history of violent behavior was significantly lower than in those with no such history.•None of the CSF flow parameters were associated with patient age. However, the aqueduct area tended to be larger in those with an earlier age of onset of the disorder.•As the number of hospitalizations increased, the average velocity and flow over the range studied decreased significantly. Patients with schizophrenia show progressive clinical deterioration. Brain abnormalities have been suggested in these patients, including enlargement of the lateral ventricles, increased cerebrospinal fluid (CSF) volume and reductions in the frontal and temporal lobes. CSF flow pathology is a central factor in the development of many neurological disorders, but much less is known about the role of CSF flow dynamics in schizophrenia. In this study, parameters of CSF flow dynamics at the aqueduct level of 50 schizophrenic patients were compared to those of 50 controls using phase-contrast cine magnetic resonance imaging. Patients had lower peak velocity, lower net forward volume, and lower average flow over the range studied than controls. The average velocity was significantly lower in patients exhibiting violent behavior compared to non-violent patients. The aqueduct tendedto be larger in schizophrenic patients with earlier age of onset of the disorder. Furthermore, as the number of hospitalizations increased, the average velocity and flow over the range studied decreased commensurately. This study demonstrated that CSF flow dynamics are altered in patients with schizophrenia. The results indicated that additional studies of CSF flow dynamics in schizophrenia are needed, along with volumetric examinations of the brain, to elucidate the pathophysiology of the disease.