Transcriptome-informed brain cartography of polygenic risk and association with brain structure in major psychiatric disorders.

Psychiatric disorders are complex, polygenic conditions characterized by patterned structural brain alterations. Whether these changes reflect transcriptional dysregulation driven by genetic risk remains unclear. We introduce a novel imaging-transcriptomics framework that integrates transcriptome-wide association studies (TWAS) with brain transcriptomic atlases to predict macroscale structural brain abnormalities across seven disorders: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anorexia nervosa (AN), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and schizophrenia (SCZ). We generated disorder-related Gene Expression-based Disorder Associated Risk (GEDAR) maps and assessed their spatial correlation with observed brain alterations thereby establishing a structured approach to map polygenic transcriptional risk onto macroscale brain phenotypes. We found significant transcriptomic-anatomical correlations in MDD (cortical and subcortical), SCZ (subcortical), and ADHD (subcortical), indicating that regional transcriptional vulnerability might contribute to varying extents to the anatomical expression of genetic risk in these disorders. Pathway enrichment analysis on genetically predicted differentially expressed genes for those disorders where we found spatial correlations between GEDAR maps and observed structural changes revealed immune-related processes as dominant in MDD and SCZ, and neurodevelopmental pathways in ADHD. Importantly, spatial transcriptomic-anatomical alignment did not scale with between-disorder differences in heritability, pointing instead toward additional influences like developmental timing or environmental interactions. These findings underscore the potential and limitations of imaging transcriptomics as a framework for bridging the gap between genetic architecture and systems-level brain changes in psychiatric disorders.