MRI procedure:

All MRI studies were performed using the same 1.5 T system (Siemens Magnetom Avanto, Erlangen, Germany). The study protocol included sagittal T1- MPRAGE (TR/TE 1900/3.4, isotropic voxel size 1 mm), axial FLAIR (TR/TE/TI 8500/89/115, slice thickness/5 mm), axial T2*-FLASH (TR/TE 814/26, sl 3 mm), axial triple echo T2-TSE (TR/TE/ TE/TE 3000/98/65/11, sl 3 mm), trueFISP (TR/TE 6.9/3.5, isotropic voxel size 0.8 mm), and T1-MPRAGE after the administration of 0.2 mmol/kg GdDTPA.

The linear measurements of the pineal gland were obtained automatically for each patient using the appropriate measurement software for previously acquired T1 weighted MRI images. We used FLAIR and T1-weighted images because they provided better contrast resolution for the gland than did the T2- weighted sequences. The neuroradiological measurements were performed by expert research radiologists who were kept blind to other protocol data, the diagnosis, and the identity of the patients. The quadrigeminal cisterna, the superior colliculus and the posterior part of the third ventricle were used as guides for the selection of the axial cuts. The pineal boundary was identified exactly on the sagittal sections taken in addition to the coronal and axial views. The maximum width (W) and height (H) of the pineal gland were measured on the medial coronal images and the length (L) was measured on the axial images. The volume (V) was calculated according to the following formula: V=1/2xHxLxW.

Statistical analysis

The Statistical Package for Social Sciences (SPSS for Windows, version 17.0, SPSS, Chicago, IL, USA) was used for statistical analysis. Student's t-test was used to compare the mean age of the patients. Chi-square analyses were used to assess the gender distribution. Kruskal Wallis and U Mann-Whitney tests were used to compare more than two groups that did not meet the normal distribution. ANOVA and post hoc tests were used to compare groups that met the normal distribution. The Pearson’s coefficient was used to investigate correlations between pineal gland volume and age, age at illness onset, duration of illness, and treatment duration, value of p.

Demographic data for the patients and controls are presented in Table 1. The differences between the ages and gender compositions of the patient and control groups were not significant (p>0.05). The mean total pineal volume was 99.73±12.03 mm³ in the controls, 95.19±11.61 mm³ in the UD patients, 93.62±11.00 mm³ in the BD patients and 83.5±10.11 mm³ in the patients with schizophrenia.

In addition, when patient groups were compared with each other, the pineal gland volume of the patients with schizophrenia was significantly smaller than those of the depressive and bipolar patients (p=0.005 and p=0.018, respectively). Although pineal gland volume in the BD group was smaller than that of the UD group, it was not statistically significant (p=0.721). In patients with schizophrenia, the relationships between pineal gland volume and onset age of the disease (r=-0.243, p=0.403), duration of the disease (r=-0.335, p=0.242) and duration of treatment (r=-0.238, p=0.412) were not statistically significant. In addition, the average pineal gland volume of women was smaller than that of men in schizophrenia group, but it was not statistically significant (77.9±7.4 mm³ vs. 86.4±10.4 mm³, respectively, p=0.128).

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