Structural neuroimaging has provided some of the most robust evidence of biologic abnormalities in the brains of patients with schizophrenia. Limbic and ventricular abnormalities now have been replicated in many studies. Despite this progress, more than two decades of research in structural neuroimaging have failed to identify the pathophysiology underlying schizophrenia. In this article we review the principal literature on structural neuroimaging, identify methodologic problems and critically evaluate the significance of the results obtained to date. As image resolution and processing ability improves and this line of research is combined with others, we can expect significant advances in our knowledge of the pathophysiology and the importance of brain abnormalities in the life of patients with schizophrenia.