Abstract / Summary
Abstract Background Emerging evidence highlights the roles of lung-brain axis in the systemic effects of chronic pulmonary disease, but cerebral metabolic and network manifestations in pulmonary fibrosis (PF) remain poorly characterized. The relationship between cerebral metabolism and clinical outcomes in PF was therefore investigated. Results Compared with healthy controls, patients with PF exhibited hypometabolism in frontal, temporal, insular, cingulate, and caudate regions (all P < 0.05). Significant disruption was identified within the parasympathetic-associated subnetwork ( P < 0.001), whereas no significant alteration was detected in the sympathetic-associated subnetwork ( P = 0.1582). Cerebral metabolism was modestly associated with pulmonary function and systemic inflammatory markers (| r | = 0.213–0.373, P < 0.05). After adjustment for age, sex, forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO), hypometabolism in selected autonomic and association regions remained associated with poorer EFS (HR = 0.426–0.632, P ≤ 0.048). Conclusions PF was associated with widespread cerebral hypometabolism and metabolic network disruption, particularly within the parasympathetic-associated network. Cerebral metabolic alterations may provide prognostic information beyond conventional pulmonary function measures.