To the Editor We believe that Blackman et al have overestimated the usefulness of magnetic resonance imaging (MRI) due to their definition of “clinically relevant.” What is considered clinically relevant may have changed between 1991 and 2021 (the time range of included studies), affecting radiologist reports and referral rates, and thus, prevalence estimates. More importantly, their definition is removed from the primary reason why physicians order neuroimaging in first-episode psychosis (FEP), that is, to exclude structural and potentially reversible causes of psychosis.