Abnormal Degree Centrality in Zoster-Associated Pain with or Without Psychiatric Comorbidities: A Resting-State Functional MRI Study.

Purpose: Zoster-associated pain (ZAP) is frequently concomitant with psychiatric comorbidities. However, the underlying neuropathological mechanisms of ZAP with psychiatric comorbidities remain poorly understood. Patients and Methods: Rest-stating functional MRI (rs-fMRI) data from 41 ZAP patients without anxiety or depression (noA/D-ZAP), 11 ZAP patients with anxiety or depression (A/D-ZAP) and 29 healthy controls (HCs) were acquired. Degree centrality (DC) based on rs-fMRI was used to explore the node changes in the brain functional network in these subjects. Moreover, correlations and receiver operating characteristic curve analysis were performed. Results: One-way analysis of variance revealed abnormal DC values in the right middle frontal gyrus (MFG) and bilateral precuneus among the three groups. Compared with HCs, A/D-ZAP showed increased DC values in the bilateral pons, while noA/D-ZAP showed increased DC values in the right pons, left brainstem and rectal gyrus and decreased DC values in the right cingulate gyrus and bilateral precuneus. A/D-ZAP showed increased DC values in the left MFG and precentral gyrus (PG) compared with noA/D-ZAP. The DC value of the left pons in A/D-ZAP was positively correlated with the self-rating anxiety scale score. Areas under the curve of DC values in the left PG and MFG for distinguishing A/D-ZAP from the noA/D-ZAP group were 0.907 and 1.000, respectively. Conclusion: This study revealed the node differences in the brain functional network of ZAP patients with or without psychiatric comorbidities. In particular, abnormal DC values of the left MFG and PG may play an important role in the neuropathologic mechanism of the disease.

Alterations in amygdala subregions-Default mode network connectivity after treatment in patients with schizophrenia.

Disrupted connectivity in the default mode network (DMN) during resting-state functional MRI (rs-fMRI) is well-documented in schizophrenia (SCZ). The amygdala, a key component in the neurobiology of SCZ, comprises distinct subregions that may exert varying effects on the disorder. This study aimed to investigate variations in functional connectivity (FC) between distinct amygdala subregions and the DMN in SCZ individuals and explore the effects of treatment on these connections. Fifty-six SCZ patients and 51 healthy controls underwent FC analysis and questionnaire surveys during resting state. The amygdala was selected as the region of interest (ROI) and subdivided into four parts. Changes in FC were examined, and correlations between questionnaire scores and brain activity were explored. Pre-treatment, SCZ patients exhibited reduced FC between the amygdala and DMN compared to HCs. After treatment, significant differences persisted in the right medial amygdala, while other regions did not differ significantly from controls. In addition, PANSS scores positively correlated with FC between the Right Medial Amygdala and the left SMFC (r = .347, p = .009), while RBANS5A scores showed a positive correlation with FC between the Left Lateral Amygdala and the right MTG (rho = -.347, p = .009). The rsFC between the amygdala and the DMN plays a crucial role in the treatment mechanisms of SCZ. This could provide a promising predictive indicator for understanding the neural mechanisms behind treatment and symptomatic improvement.

Brain neuroplasticity in multiple sclerosis patients in functional magnetic resonance imaging studies. Part 2: Effect of aerobic training.

Purpose: The aim of this study was to evaluate the effects of aerobic training on motor cortical areas in multiple sclerosis (MS) patients, based on task-based functional magnetic resonance imaging (t-fMRI) as well as on brain activity at rest, according to resting state functional MRI (rs-fMRI) studies. Material and methods: Multiple sclerosis patients were divided into 2 groups consisting of 14 participants each: the MS study group and the MS control group. All MS patients underwent clinical assessment and MRI examination, twice: in the MS study group at the time of inclusion in the study and after a 4-week period of aerobic training, whereas in the MS control group it happened at the time of inclusion and after a period of one month without exercise rehabilitation. The MRI study protocol included rs-fMRI and t-fMRI sequences, which were the grounds for an analysis of resting state networks (RSN) as well as peak level and cluster level parameters within motor cortex areas - the primary motor cortex, premotor area, and supplementary motor area, respectively. Results: In the MS study group, aerobic training improved the clinical condition and decreased the functional correlation between the sensorimotor network and the salience network. Also, significant decreases of the mean cluster level (72.42 vs. 38.35) and peak level values (10.89 vs. 7.64) were observed in the contralateral primary motor cortex in this group of patients between examinations. Conclusions: Aerobic training not only improves physical performance but also contributes to changes in brain activity - both within RSN and motor cortex areas in MS patients.

Visual contrast sensitivity is associated with community structure integrity in cognitively unimpaired older adults: the Brain Networks and Mobility (B-NET) Study.

Older adults with impairment in contrast sensitivity (CS), the ability to visually perceive differences in light and dark, are more likely to demonstrate limitations in mobility function, but the mechanisms underlying this relationship are poorly understood. We sought to determine if functional brain networks important to visual processing and mobility may help elucidate possible neural correlates of this relationship. This cross-sectional analysis utilized functional MRI both at rest and during a motor imagery (MI) task in 192 community-dwelling, cognitively-unimpaired older adults ≥ 70 years of age from the Brain Networks and Mobility study (B-NET). Brain networks were partitioned into network communities, groups of regions that are more interconnected with each other than the rest of the brain, the spatial consistency of the communities for multiple brain subnetworks was assessed. Lower baseline binocular CS was significantly associated with degraded sensorimotor network (SMN) community structure at rest. During the MI task, lower binocular CS was significantly associated with degraded community structure in both the visual (VN) and default mode network (DMN). These findings may suggest shared neural pathways for visual and mobility dysfunction that could be targeted in future studies.

Effect of a four-week oral Phe administration on neural activation and cerebral blood flow in adults with early-treated phenylketonuria.

BACKGROUND: Phenylketonuria (PKU) is a rare inborn error of metabolism characterized by impaired catabolism of the amino acid phenylalanine (Phe) into tyrosine. Cross-sectional studies suggest slight alterations in cognitive performance and neural activation in adults with early-treated PKU. The influence of high Phe levels on brain function in adulthood, however, remains insufficiently studied. Therefore, we aimed to explore the effect of a four-week period of oral Phe administration - simulating a controlled discontinuation of Phe restriction and raising Phe to an off-diet scenario - on working memory-related neural activation and cerebral blood flow (CBF). METHODS: We conducted a randomized, placebo-controlled, double-blind, crossover, non-inferiority trial to assess the effect of a high Phe load on working memory-related neural activation and CBF in early-treated adults with classical PKU. Twenty-seven patients with early-treated classical PKU were included and underwent functional magnetic resonance imaging (fMRI) of the working memory network and arterial spin labeling (ASL) MRI to assess CBF before and after a four-week intervention with Phe and placebo. At each of the four study visits, fMRI working memory task performance (reaction time and accuracy) and plasma Phe, tyrosine, and tryptophan levels were obtained. Additionally, cerebral Phe was determined by 1H-MR spectroscopy. RESULTS: Plasma Phe and cerebral Phe were significantly increased after the Phe intervention. However, no significant effect of Phe compared to placebo was found on neural activation and CBF. Regarding fMRI task performance, a significant impact of the Phe intervention on 1-back reaction time was observed with slower reaction times following the Phe intervention, whereas 3-back reaction time and accuracy did not differ following the Phe intervention compared to the placebo intervention. CONCLUSION: Results from this present trial simulating a four-week discontinuation of the Phe-restricted diet showed that a high Phe load did not uniformly affect neural markers and cognition in a statistically significant manner. These results further contribute to the discussion on safe Phe levels during adulthood and suggest that a four-week discontinuation of Phe-restricted diet does not demonstrate significant changes in brain function.

Immediate and long-term brain activation of acupuncture on ischemic stroke patients: an ALE meta-analysis of fMRI studies.

Background: Acupuncture, as an alternative and complementary therapy recommended by the World Health Organization for stroke treatment, holds potential in ameliorating neurofunctional deficits induced by ischemic stroke (IS). Understanding the immediate and long-term effects of acupuncture and their interrelation would contribute to a better comprehension of the mechanisms underlying acupuncture efficacy. Methods: Activation likelihood estimation (ALE) meta-analysis was used to analyze the brain activation patterns reported in 21 relevant functional neuroimaging studies. Among these studies, 12 focused on the immediate brain activation and 9 on the long-term activation. Single dataset analysis were employed to identify both immediate and long-term brain activation of acupuncture treatment in IS patients, while contrast and conjunction analysis were utilized to explore distinctions and connections between the two. Results: According to the ALE analysis, immediately after acupuncture treatment, IS patients exhibited an enhanced cluster centered around the right precuneus (PCUN) and a reduced cluster centered on the left middle frontal gyrus (MFG). After long-term acupuncture treatment, IS patients showed an enhanced cluster in the left PCUN, along with two reduced clusters in the right insula (INS) and hippocampus (HIP), respectively. Additionally, in comparison to long-term acupuncture treatment, the right angular gyrus (ANG) demonstrated higher ALE scores immediately after acupuncture, whereas long-term acupuncture resulted in higher scores in the left superior parietal gyrus (SPG). The intersecting cluster activated by both of them was located in the left cuneus (CUN). Conclusion: The findings provide initial insights into both the immediate and long-term brain activation patterns of acupuncture treatment for IS, as well as the intricate interplay between them. Both immediate and long-term acupuncture treatments showed distinct patterns of brain activation, with the left CUN emerging as a crucial regulatory region in their association. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42023480834.

Absence of BOLD adaptation in chronic fatigue syndrome revealed by task functional MRI.

Neurological symptoms are central to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), yet its underlying neurophysiological mechanisms remain elusive. We examined a neglected aspect of task-based functional MRI, focusing on how blood oxygenation level-dependent (BOLD) signals alter during cognitive tasks in ME/CFS. This prospective observational study utilised MRI scans on ME/CFS participants and healthy controls (HCs) with sedentary lifestyles (ACTRN12622001095752). Participants completed two blocks of a Symbol Digit Modalities Test, with 30 trials per block split into two sets. The fMRI signal changes between blocks and sets were compared within and between groups. Thirty-four ME/CFS participants (38 years ± 10; 27 women) and 34 HCs (38 ± 10; 27 women), were evaluated. In the second task block, ME/CFS participants exhibited increased activation in the right postcentral gyrus, contrasting with decreased activation in multiple regions in HCs. These results were further confirmed by significantly higher bilateral dynamic changes (2nd vs 1st set) in the motor, sensory and cognitive cortex in ME/CFS compared to HCs and significant correlations between those changes in the left primary motor cortex with fatigue severities. BOLD adaptation, potentially improving energy economy, was absent in ME/CFS, which may provide an underlying neurophysiological process in ME/CFS.

Age dictates brain functional connectivity and axonal integrity following repetitive mild traumatic brain injuries in mice.

Traumatic brain injuries (TBI) present a major public health challenge, demanding an in-depth understanding of age-specific symptoms and risk factors. Aging not only significantly influences brain function and plasticity but also elevates the risk of hospitalizations and death following TBIs. Repetitive mild TBIs (rmTBI) compound these issues, resulting in cumulative and long-term brain damage in the brain. In this study, we investigate the impact of age on brain network changes and white matter properties following rmTBI by employing a multi-modal approach that integrates resting-state functional magnetic resonance imaging (rsfMRI), graph theory analysis, diffusion tensor imaging (DTI), and neurite orientation dispersion and density imaging (NODDI). Our hypothesis is that the effects of rmTBI are worsened in aged animals, with this group showing more pronounced alterations in brain connectivity and white matter structure. Utilizing the closed-head impact model of engineered rotational acceleration (CHIMERA) model, we conducted rmTBIs or sham (control) procedures on young (2.5-3-months-old) and aged (22-months-old) male and female mice to model high-risk groups. Functional and structural imaging unveiled age-related reductions in communication efficiency between brain regions, while injuries induced opposhigh-risking effects on the small-world index across age groups, influencing network segregation. Functional connectivity analysis also identified alterations in 79 out of 148 brain regions by age, treatment (sham vs. rmTBI), or their interaction. Injuries exerted pronounced effects on sensory integration areas, including insular and motor cortices. Age-related disruptions in white matter integrity were observed, indicating alterations in various diffusion directions (mean diffusivity, radial diffusivity, axial diffusivity, and fractional anisotropy) and density neurite properties (dispersion index, intracellular and isotropic volume fraction). Neuroinflammation, assessed through Iba-1 and GFAP markers, correlated with higher dispersion in the optic tract, suggesting a neuroinflammatory response in injured aged animals compared to sham aged. These findings offer insight into the interplay between age, injuries, and brain connectivity, shedding light on the long-term consequences of rmTBI.

Brain dynamics supported by a hierarchy of complex correlation patterns defining a robust functional architecture.

Functional magnetic resonance imaging (fMRI) provides insights into cognitive processes with significant clinical potential. However, delays in brain region communication and dynamic variations are often overlooked in functional network studies. We demonstrate that networks extracted from fMRI cross-correlation matrices, considering time lags between signals, show remarkable reliability when focusing on statistical distributions of network properties. This reveals a robust brain functional connectivity pattern, featuring a sparse backbone of strong 0-lag correlations and weaker links capturing coordination at various time delays. This dynamic yet stable network architecture is consistent across rats, marmosets, and humans, as well as in electroencephalogram (EEG) data, indicating potential universality in brain dynamics. Second-order properties of the dynamic functional network reveal a remarkably stable hierarchy of functional correlations in both group-level comparisons and test-retest analyses. Validation using alcohol use disorder fMRI data uncovers broader shifts in network properties than previously reported, demonstrating the potential of this method for identifying disease biomarkers.

Breaking (musical) boundaries by investigating brain dynamics of event segmentation during real-life music-listening.

The perception of musical phrase boundaries is a critical aspect of human musical experience: It allows us to organize, understand, derive pleasure from, and remember music. Identifying boundaries is a prerequisite for segmenting music into meaningful chunks, facilitating efficient processing and storage while providing an enjoyable, fulfilling listening experience through the anticipation of upcoming musical events. Expanding on Sridharan et al.'s [Neuron 55, 521-532 (2007)] work on coarse musical boundaries between symphonic movements, we examined finer-grained boundaries. We measured the fMRI responses of 18 musicians and 18 nonmusicians during music listening. Using general linear model, independent component analysis, and Granger causality, we observed heightened auditory integration in anticipation to musical boundaries, and an extensive decrease within the fronto-temporal-parietal network during and immediately following boundaries. Notably, responses were modulated by musicianship. Findings uncover the intricate interplay between musical structure, expertise, and cognitive processing, advancing our knowledge of how the brain makes sense of music.

Dynamic causal modelling highlights the importance of decreased self-inhibition of the sensorimotor cortex in motor fatigability.

Motor fatigability emerges when challenging motor tasks must be maintained over an extended period of time. It is frequently observed in everyday life and affects patients as well as healthy individuals. Motor fatigability can be measured using simple tasks like finger tapping at maximum speed for 30 s. This typically results in a rapid decrease of tapping frequency, a phenomenon called motor slowing. In a previous study (Bächinger et al, eLife, 8 (September), https://doi.org/10.7554/eLife.46750 , 2019), we showed that motor slowing goes hand in hand with a gradual increase in blood oxygen level dependent signal in the primary sensorimotor cortex (SM1), supplementary motor area (SMA), and dorsal premotor cortex (PMd). It is unclear what drives the activity increase in SM1 caused by motor slowing and whether motor fatigability affects the dynamic interactions between SM1, SMA, and PMd. Here, we performed dynamic causal modelling (DCM) on data of 24 healthy young participants collected during functional magnetic resonance imaging to answer this question. The regions of interest (ROI) were defined based on the peak activation within SM1, SMA, and PMd. The model space consisted of bilateral connections between all ROI, with intrinsic self-modulation as inhibitory, and driving inputs set to premotor areas. Our findings revealed that motor slowing was associated with a significant reduction in SM1 self-inhibition, as uncovered by testing the maximum à posteriori against 0 (t(23)=-4.51, p < 0.001). Additionally, the model revealed a significant decrease in the driving input to premotor areas (t(23) > 2.71, p < 0.05) suggesting that structures other than cortical motor areas may contribute to motor fatigability.

Changes in MRI head motion across development: typical development and ADHD.

Head motion is a major confounding variable for magnetic resonance imaging (MRI) analysis, and is commonly seen in individuals with neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD). This study investigated the trajectory of change in head motion in typically developing children and children with ADHD, and examined possible altered trajectories in head motion between children with remitted and persistent ADHD. 105 children with ADHD and 84 controls completed diffusion and resting-state functional MRI scans at up to three waves over ages 9-14 years. In-scanner head motion was calculated using framewise displacement, and longitudinal trajectories analyzed using generalized additive mixed modelling. Results revealed a significant age effect on framewise displacement where head motion decreased as age increased during both diffusion (p < .001) and resting-state functional MRI (p < .001). A significant effect of group was also observed; children with ADHD displayed greater framewise displacement than controls over the age range (diffusion MRI p = .036, functional MRI p = .004). Further analyses revealed continued elevation in head motion in children in remission from ADHD (diffusion MRI p = .020, functional MRI p = .011) compared to controls. Rates of change in head motion did not significantly differ between diagnostic groups. Findings indicate a critical link between in-scanner head motion and developmental age within children regardless of ADHD diagnosis, important to consider in studies of neurodevelopment. Findings also suggest change in head motion with age does not differ between individuals with remitted and persistent ADHD, adding further evidence that behavioral manifestations of ADHD may continue despite clinical remission.

TMS-induced plasticity improving cognitive control in OCD I: Clinical and neuroimaging outcomes from a randomised trial.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for obsessive-compulsive disorder (OCD). The neurobiological mechanisms of rTMS in OCD have been incompletely characterized. We compared clinical outcomes and changes in task-based brain activation following three different rTMS stimulation protocols, all combined with exposure and response prevention (ERP). METHODS: In this three-arm proof-of-concept randomized trial, 61 treatment-refractory adult OCD patients received 16 sessions of rTMS immediately prior to ERP over 8 weeks, with task-based functional MRI (tb-fMRI) scans and clinical assessments pre- and post-treatment. Patients received either: high frequency (HF) rTMS to the left dorsolateral prefrontal cortex (DLPFC)(n=19(6M/13F)); HF rTMS to the left pre-supplementary motor area (preSMA)(n=23(10M/13F)); or control rTMS to the vertex(n=19(6M/13F)). Changes in tb-fMRI activation pre-post treatment were compared using both a Bayesian region-of-interest and a general linear model whole-brain approach. RESULTS: Mean OCD symptom severity decreased significantly in all treatment groups (delta=-10.836, p<0.001, 95% CI[-12.504,-9.168]), with no differences between groups. Response rate in the entire sample was 57.4%. The DLPFC rTMS group showed decreased planning-related activation post-treatment that was associated with greater symptom improvement. No group-level activation changes were observed for the preSMA or vertex rTMS groups. Participants with greater symptom improvement in the preSMA group showed decreased error-related activation, and symptom improvement in the vertex group was associated with increased inhibition-related activation. CONCLUSIONS: PreSMA and DLPFC rTMS combined with ERP led to activation decreases in targeted task networks in individuals showing greater symptom improvement, although we observed no differences in symptom reduction between groups.

From Maps to Models: A Survey on the Reliability of Small Studies of Task-Based fMRI.

Task-based functional magnetic resonance imaging is a powerful tool for studying brain function, but neuroimaging research produces ongoing concerns regarding small-sample studies and how to interpret them. Although it is well understood that larger samples are preferable, many situations require researchers to make judgments from small studies, including reviewing the existing literature, analyzing pilot data, or assessing subsamples. Quantitative guidance on how to make these judgments remains scarce. To address this, we leverage the Human Connectome Project's Young Adult dataset to survey various analyses-from regional activation maps to predictive models. We find that, for some classic analyses such as detecting regional activation or cluster peak location, studies with as few as 40 subjects are adequate, although this depends crucially on effect sizes. For predictive modeling, similar sizes can be adequate for detecting whether features are predictable, but at least an order of magnitude more (at least hundreds) may be required for developing consistent predictions. These results offer valuable insights for designing and interpreting fMRI studies, emphasizing the importance of considering effect size, sample size, and analysis approach when assessing the reliability of findings. We hope that this survey serves as a reference for identifying which kinds of research questions can be reliably answered with small-scale studies.

Dose-dependent target engagement of a clinical iTBS protocol: An interleaved TMS-fMRI study in healthy subjects.

BACKGROUND: Intermittent theta burst stimulation (iTBS) of the dorsolateral prefrontal cortex (DLPFC) is widely applied as therapeutic intervention in mental health, however understanding of its mechanisms is still incomplete. Prior MRI studies have mainly used offline iTBS or short sequences in concurrent TMS-fMRI. This study investigated a full 600 stimuli iTBS protocol using interleaved TMS-fMRI in comparison with two control conditions in healthy subjects. METHODS: In a crossover design, 18 participants underwent three sessions of interleaved iTBS-fMRI: 1) left DLPFC at 40% resting motor threshold (rMT) intensity, 2) left DLPFC at 80% rMT intensity, and 3) left primary motor cortex (M1) at 80% rMT intensity. We compared immediate blood-oxygen-level-dependent (BOLD) responses during interleaved iTBS-fMRI across these conditions including correlations between individual fMRI BOLD activation and iTBS induced electric field (E-field) strength at the target sites. RESULTS: Whole-brain analysis showed increased activation in several regions following iTBS. Specifically, left DLPFC, as well as bilateral M1, anterior cingulate cortex, and insula showed increased activation during 80% rMT left DLPFC stimulation. Increased BOLD activity in the left DLPFC was not observed with 40% rMT left DLPFC stimulation nor left M1 80% rMT iTBS, whereas activation in other regions was found to overlap between conditions. Of note, BOLD activation and E-field intensities were only correlated for M1 stimulation, but not for the DLPFC conditions. CONCLUSIONS: The study showed dosage and target specific BOLD activation during interleaved TMS-fMRI with 600 stimuli iTBS in healthy subjects. Future studies may use our approach for demonstrating target engagement.

The hemodynamic response to co-occurring interictal epileptiform discharges and high-frequency oscillations localizes the seizure-onset zone.

OBJECTIVE: To use intracranial electroencephalography (EEG) to characterize functional magnetic resonance imaging (fMRI) activation maps associated with high-frequency oscillations (HFOs) (80-250 Hz) and examine their proximity to HFO- and seizure-generating tissue. METHODS: Forty-five patients implanted with intracranial depth electrodes underwent a simultaneous EEG-fMRI study at 3 T. HFOs were detected algorithmically from cleaned EEG and visually confirmed by an experienced electroencephalographer. HFOs that co-occurred with interictal epileptiform discharges (IEDs) were subsequently identified. fMRI activation maps associated with HFOs were generated that occurred either independently of IEDs or within ±200 ms of an IED. For all significant analyses, the Maximum, Second Maximum, and Closest activation clusters were identified, and distances were measured to both the electrodes where the HFOs were observed and the electrodes involved in seizure onset. RESULTS: We identified 108 distinct groups of HFOs from 45 patients. We found that HFOs with IEDs produced fMRI clusters that were closer to the local field potentials of the corresponding HFOs observed within the EEG than HFOs without IEDs. In addition to the fMRI clusters being closer to the location of the EEG correlate, HFOs with IEDs generated Maximum clusters with greater z-scores and larger volumes than HFOs without IEDs. We also observed that HFOs with IEDs resulted in more discrete activation maps. SIGNIFICANCE: Intracranial EEG-fMRI can be used to probe the hemodynamic response to HFOs. The hemodynamic response associated with HFOs that co-occur with IEDs better identifies known epileptic tissue than HFOs that occur independently.

A Prospective Study of Role of Functional MRI in Suspects of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) syndrome, characterized by daytime impairment, affects approximately 1 in 20 adults and can lead to a range of behavioral and cardiovascular abnormalities. Understanding the underlying causes and identifying the specific obstructions within the upper airway is crucial for effective management of this condition. Sleep MRI has emerged as a valuable tool in accurately diagnosing OSA by providing detailed insights into the level, magnitude, and type of obstruction present in affected individuals. One of the key observations made through sleep MRI studies is the increased collapsibility of the velopharynx in apneic patients, particularly during sleep. This heightened collapsibility predisposes the airway to occlusion, contributing to the repetitive breathing pauses characteristic of OSA. By visualizing the dimensions and configurations of the upper airway during both wakefulness and sleep, sleep MRI enables clinicians to pinpoint structural and dynamic factors that play a role in the development and progression of OSA. Moreover, the information gleaned from sleep MRI scans can inform the development of personalized treatment strategies for OSA patients. By identifying specific anatomical abnormalities and dynamic changes in the upper airway, clinicians can tailor interventions such as continuous positive airway pressure (CPAP), oral appliances, or surgical procedures to address the underlying causes of obstruction more effectively. Sleep MRI serves as a powerful diagnostic tool in the management of OSA, offering detailed anatomical and functional insights that guide treatment planning and optimization. Its ability to uncover structural and dynamic factors contributing to airway obstruction enhances our understanding of OSA pathophysiology and facilitates targeted therapeutic interventions aimed at improving patient outcomes and quality of life.