Morphological analysis and functional connectivity of the insular in patients with dysphagia after cerebral infarction based on resting-state fMRI

Objective The insula, as a critical hub for multimodal information integration, plays a pivotal role in post-stroke dysphagia(PSD). However, the mechanisms underlying its structural and functional network reorganization remain elusive. This study aims to systematically investigate the alterations in...

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Veröffentlicht in:BMC neurology Jg. 25; H. 1; S. 307 - 13
Hauptverfasser: Guo, Ming, Li, Bingjie, Zhao, Jun, Bai, Chen, Yu, Weiyong, Zhang, Hongxia, Li, Haoyuan, Yuan, Yongxue, Zhang, Qingsu, Zhang, Tong
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 30.07.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Activities of daily living
Aged
Analysis
Atrophy
Automation
Brain
Brain research
Care and treatment
Cerebellum
Cerebral Cortex - pathology
Cerebral infarction
Cerebral Infarction - complications
Cerebral Infarction - diagnostic imaging
Cerebral Infarction - pathology
Cerebral Infarction - physiopathology
Complications and side effects
Cortex (frontal)
Cortex (insular)
Cortex (parietal)
Data analysis
Deglutition disorders
Deglutition Disorders - diagnostic imaging
Deglutition Disorders - etiology
Deglutition Disorders - pathology
Deglutition Disorders - physiopathology
Diagnosis
Dysphagia
Female
Functional
Functional magnetic resonance imaging
Gray Matter - diagnostic imaging
Gray Matter - pathology
Gray matter volume
Humans
Insula
Insular Cortex - diagnostic imaging
Insular Cortex - pathology
Insular Cortex - physiopathology
Magnetic Resonance Imaging
Male
Management information systems
Medicine
Medicine & Public Health
Middle Aged
Morphological variation
Morphometry
Neural networks
Neurochemistry
Neuroimaging
Neurology
Neurosurgery
Occipital lobe
Operculum
Rehabilitation
Rest
Resting-state functional magnetic resonance imaging
Risk factors
Sensory integration
Software
Stroke
Stroke (Disease)
Structure-function relationships
Substantia grisea
Superior cerebellar peduncle
Swallowing
China
Beijing China
Functional
Insula
Dysphagia
Gray matter volume
Resting-state functional magnetic resonance imaging
ISSN:1471-2377, 1471-2377
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Zusammenfassung:Objective The insula, as a critical hub for multimodal information integration, plays a pivotal role in post-stroke dysphagia(PSD). However, the mechanisms underlying its structural and functional network reorganization remain elusive. This study aims to systematically investigate the alterations in gray matter volume and functional connectivity patterns of the insula in patients with dysphagia after cerebral infarction using multimodal neuroimaging techniques, and to untangle their clinical associations with swallowing function impairments. Methods Three groups of subjects were recruited: healthy controls (HC, n = 15), cerebral infarction patients without dysphagia (ND, n = 13), and cerebral infarction patients with dysphagia (DYS, n = 11). Resting-state functional magnetic resonance imaging (rs-fMRI) and high-resolution T1-weighted structural imaging data were acquired. Seed-based analysis (using the CONN FC toolbox) was employed to quantify the whole-brain functional connectivity (FC) of the insula, and voxel-based morphometry (VBM) was used to assess gray matter volume changes. Swallowing function was standardized using the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and the Penetration/Aspiration Scale (PAS). Results The DYS, ND, and HC groups showed significant differences in grey matter volume in the left insula ( p FDR =0.041). Compared to the HC group, both cerebral infarction groups (ND and DYS) demonstrated increased functional connectivity between the left insula and the left lateral occipital cortex (superior division), left precuneus, and left cerebellum. In contrast, functional connectivity with the right insula cortex, right frontal operculum cortex, left anterior cingulate, and right frontal pole was decreased. Among these differences, compared to the ND group, the DYS group showed a more significant reduction in functional connectivity within the right frontal operculum cortex and a more pronounced increase in functional connectivity within the left lateral occipital cortex superior division and left cerebellum. Compared to the HC group, patients in both cerebral infarction groups (ND and DYS) showed significantly enhanced functional connectivity between the right insula and the right posterior cingulate gyrus, left lateral occipital cortex (superior division), right precuneus, left frontal pole and right frontal pole. Conversely, functional connectivity with the left insula cortex and left anterior cingulate gyrus was significantly reduced. Moreover, compared to the ND group, the DYS group demonstrated more pronounced increases in functional connectivity within the right posterior cingulate gyrus and right superior cerebellar peduncle, along with a more significant decrease in functional connectivity within the right insula cortex. Enhanced FC between the left insula and the left lateral occipital cortex (superior division) correlated positively with PAS, while enhanced FC between the right insula and the right cerebellum correlated negatively with PAS. Conclusion Our study found left insular gray matter atrophy underlies the pathology of PSD, and abnormal insular functional connectivity is key to its development. The severity of post-stroke dysphagia can affect the functional connectivity between the insula and the right cerebellum as well as the left occipital lobe. These results reveal potential neural compensation mechanisms in PSD and offer new directions for clinical prognostic biomarker development.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1471-2377
1471-2377
DOI:10.1186/s12883-025-04322-1