Forty years of structural brain imaging in mental disorders: is it clinically useful or not?

Structural brain imaging was introduced into routine clinical practice more than 40 years ago with the hope that it would support the diagnosis and treatment of mental disorders. It is now widely used to exclude organic brain disease (eg, brain tumors, cardiovascular, and inflammatory processes) in mental disorders. However, questions have been raised about whether structural brain imaging is still needed today and whether it could also be clinically useful to apply new biostatistical methods, such as machine learning. Therefore, the current paper not only reviews structural findings in Alzheimer disease, depression, bipolar disorder, and schizophrenia but also discusses the role of structural imaging in supporting diagnostic, prognostic, and therapeutic processes in mental disorders. Thus, it attempts to answer the questions whether, after four decades of use, structural brain imaging is clinically useful in mental disorders or whether it will become so in the future.