185: MRI MDI sequence identifies cortical biomarkers of central sensitization in neuropathic pain.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Assessment and Measurement of Pain/Nociception, Imaging (e.g. fMRI, PET, MRS)

Background and Aims: Abnormal central pain sensitization may serve as a potential explanation for persistent neuropathic pain after lumbosacral radicular pain surgery, yet its exact mechanism remains unclear. This study aimed to investigate cortical pattern changes in patients with chronic neuropathic pain secondary to lumbosacral radicular pain.

Methods: A total of 13 lumbosacral radicular pain patients (49.6±10.6 years old) and 12 age- and sex-matched healthy controls(48.5±10.4 years old) were enrolled. Multimodal MRI techniques, including structural imaging(T1w) and Multicompartment decoupling imaging(MDI), were employed to analyze gray matter volume, as well as the volume and diffusion function of intercellular spaces in regions of interest related to central sensitization. T1w volumetric images were acquired using the MP-RAGE sequence with 1 mm isotropic resolution. MDI were acquired using the multi-b value DWI sequence (using from the b=800 s/mm2 to b=1400 s/mm2 shells data).

Results: Regional gray matter volumes were significantly reduced in multiple brain regions in the lumbosacral radicular pain group(p<0.001). Significant between-group differences were observed in gray matter volume maps of the dorsolateral prefrontal cortex and periaqueductal gray(p<0.001), and these regional gray matter volumes were inversely correlated with central sensitization scores. Lumbosacral radicular pain patients exhibited an increased diffusion fraction of intercellular spaces in central sensitization-related regions(p<0.001), which was negatively correlated with symptom severity(r = -0.445, p < 0.001）. Lumbosacral radicular pain represents an important model of neuropathic pain, and all enrolled patients showed negative findings on lumbar MRI examinations.

Conclusions: Our findings may provide new insights into cortical biomarkers and potential mechanisms underlying central sensitization in persistent pain following lumbosacral radicular pain, and could lay the groundwork for exploring innovative targeted therapeutic strategies for patients who respond poorly to current treatment regimens.

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Presenting Author: Yuanren, Zhai
Submitting Author: Yuanren Zhai

Senior Author: Shuiqing, Li

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Yuanren, Zhai: MD - Peking University Third Hospital
• Shengyu, Cui: MD - Peking University Third Hospital
• Haiyue, Zhao: MD - Peking University Third Hospital
• Qipeng, Luo: MD - Peking University Third Hospital
• Shuiqing, Li: MMed - Peking University Third Hospital