Neuroimaging studies have identified several candidate biomarkers of schizophrenia. However, it is unclear whether the considerable variability in these neurobiological correlates between patients can be translated into the clinical setting.

We aimed to identify neuroimaging predictors of clinical course in patients with schizophrenia. Combined with the identification of genetically determined markers of schizophrenia risk, our studies aimed to elucidate the biological basis and the clinical relevance of inter-individual variability between patients.

We included over 150 patients with schizophrenia and 279 healthy volunteers across five neuroimaging centers in the framework of the IMAGEMEND project [1]. We performed multiple studies on MRI scans using random forests and ROC curves to predict clinical course. Data from healthy controls served to normalize the data from the clinical population and to provide a benchmark for the findings.

We identified ensembles of neuroimaging markers and of genetic variants predictive of clinical course. Results highlight that (i) brain imaging carries significant clinical information, (ii) clinical information at baseline can considerably increase prediction accuracy.

The methodological challenges and the results will be discussed in the context of recent findings from other multi-site studies. We conclude that brain imaging data on their own right are relevant to stratify patients in terms of clinical course; however, complementing these data with other modalities such as genetics and clinical information is necessary to further develop the field towards clinical application of the predictions.

Giulio Pergola is the academic supervisor of a Hoffmann-La Roche Collaboration grant that partially funds his salary.