He Miao, Liu Yubo, Guan Zhongtian, Li Chunlin, Zhang Zhixi
School of Biomedical Engineering, Capital Medical University, Beijing, China.
Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China.
Front Aging Neurosci. 2025 Feb 20;17:1550319. doi: 10.3389/fnagi.2025.1550319. eCollection 2025.
Lung diseases induce changes in brain structure and function, leading to a range of cognitive, emotional, and motor deficits. The concept of the lung-brain axis has been proposed through neuroanatomy, endocrine, and immune pathway, while a considerable number of studies also explored the existence of the lung-brain axis from a neuroimaging perspective. This survey summarizes studies exploring the relationship between lung disease and brain structure and function from neuroimaging perspective, particular in magnetic resonance imaging (MRI). We have collated existing lung diseases studies and categorized them into four types: chronic obstructive pulmonary disease (COPD), coronavirus disease 2019 (COVID-19), lung cancer and other lung diseases. The observed structural and functional changes in the brain and cognitive dysfunction induced by lung diseases are discussed. We also present distinct pattern of brain changes in various lung diseases. Neuroimaging changes in COPD are concentrated in the frontal lobes, including gray matter atrophy, white matter damage, and reduced perfusion. Patients with COVID-19 exhibit extensive microhemorrhages and neuroinflammation, brain regions functionally connected to the primary olfactory cortex show greater changes. For lung cancer patients, brain changes are mainly attributed to the neurotoxicity of radiotherapy and chemotherapy, with damage concentrated in subcortical structures, patients with cancer pain demonstrate hyperconnectivity in motor and visual networks. The survey also discusses the pathological mechanisms revealed in neuroimaging studies and clinical significance of current studies. Finally, we analyzed current limitations, mainly in terms of small sample size, non-standardized criteria, reliance on correlation analyses, lack of longitudinal studies, and absence of reliable biomarkers. We suggest future research directions should include leveraging artificial intelligence for biomarker development, conducting longitudinal and multicenter studies, and investigating the systemic effects of lung disease on the brain and neuromodulation strategies.
肺部疾病会引起脑结构和功能的改变，导致一系列认知、情感和运动缺陷。肺-脑轴的概念已通过神经解剖学、内分泌和免疫途径提出，同时也有大量研究从神经影像学角度探讨了肺-脑轴的存在。本综述总结了从神经影像学角度，特别是磁共振成像（MRI）方面，探索肺部疾病与脑结构和功能之间关系的研究。我们整理了现有的肺部疾病研究，并将其分为四类：慢性阻塞性肺疾病（COPD）、2019冠状病毒病（COVID-19）、肺癌和其他肺部疾病。文中讨论了观察到的肺部疾病引起的脑结构和功能变化以及认知功能障碍。我们还展示了各种肺部疾病中不同的脑变化模式。COPD的神经影像学变化集中在额叶，包括灰质萎缩、白质损伤和灌注减少。COVID-19患者表现出广泛的微出血和神经炎症，与初级嗅觉皮层功能连接的脑区变化更大。对于肺癌患者，脑变化主要归因于放疗和化疗的神经毒性，损伤集中在皮层下结构，癌症疼痛患者在运动和视觉网络中表现出过度连接。本综述还讨论了神经影像学研究揭示的病理机制以及当前研究的临床意义。最后，我们分析了当前的局限性，主要包括样本量小、标准不统一、依赖相关性分析、缺乏纵向研究以及缺乏可靠的生物标志物。我们建议未来的研究方向应包括利用人工智能开发生物标志物、开展纵向和多中心研究，以及研究肺部疾病对脑的全身影响和神经调节策略。
