Introduction:Schizophrenia is a complex mental illness that touches the lives of about 1% of the world's population. Modern neuroimaging techniques, especially Magnetic Resonance Imaging (MRI), can provide deep insights into the brain bases of schizophrenia. This study was designed to investigate how the findings of MRI scans might affect treatment decisions that are made in a tertiary care hospital for people with schizophrenia. Methods:A prospective observational study was conducted for one year amongst 150 patients with schizophrenia. The participants underwent comprehensive clinical assessment, along with structural and functional MRI. Decisions on treatment planning were evaluated before and after reviewing MRI. Follow-up assessments were done after 3 months in terms of the outcome of treatment. Results: Structural and functional brain imaging showed important cortical thinning in 61.3% of the cases and abnormal connectivity within the default mode network in 63.3%. MRI review led to significant changes in treatment planning, including increased rates of recommendation for cognitive remediation (30.0% vs 58.0%, p<0.001) and for changes in antipsychotic medications (21.3% vs 38.7%, respectively, p<0.001). Cortical thickness in the dorsolateral prefrontal cortex was the most important predictor of response to treatment in univariate analyses (OR = 1.8, 95% CI: 1.3-2.5, p = 0.002). Conclusion:Findings on MRI significantly influence treatment planning in schizophrenia and provide informative predictors of response to treatment. In the future, integration of neuroimaging into clinical practice promises personalization and improvement of strategies for the treatment of schizophrenia. This translation is challenging into routine clinical care and also requires further investigation into developing clinician-friendly tools for interpretation of neuroimaging data.