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• Clinical Article •
Study on brain structure-function coupling and prediction of rTMS efficacy in fibromyalgia syndrome patients based on multimodal MRI
XU Tong  ZHANG Xinran  SHI Guoji  WU Ting 

Cite this article as: XU T, ZHANG X R, SHI G J, et al. Study on brain structure-function coupling and prediction of rTMS efficacy in fibromyalgia syndrome patients based on multimodal MRI[J]. Chin J Magn Reson Imaging, 2026, 17(4): 1-9. DOI:10.12015/issn.1674-8034.2026.04.001.


[Abstract] Objective To investigate the structural-functional coupling (SC-FC) characteristics of brain networks in patients with fibromyalgia syndrome (FMS) using multimodal neuroimaging and graph theory analysis, and to validate its predictive value for the efficacy of repetitive transcranial magnetic stimulation (rTMS), thereby promoting prospective and effective treatment screening for this disorder.Materials and Methods Forty-two female FMS patients and 42 healthy controls underwent multimodal MRI. GRETNA analyzed network properties; SC-FC coupling was evaluated at multiple levels, and its correlation with Visual Analog Scale (VAS) scores was examined. Patients received 10 rTMS sessions; receiver operating characteristic (ROC) curves evaluated pre-treatment SC-FC's predictive value.Results Compared to the HC group, FMS patients showed significantly reduced local efficiency (t = -2.569, P = 0.009) and average clustering coefficient (t = -3.098, P = 0.003) in the structural network. The brain regions with significant alterations in local topology for both structural and functional networks were primarily concentrated in areas related to pain and emotion. SC-FC coupling analysis revealed a significantly decreased global SC-FC coupling level in FMS patients (t = -5.541, P < 0.001). At the nodal level, multiple brain regions exhibited bidirectional abnormal coupling values (P < 0.05, FDR corrected), while at the subnetwork level, the SC-FC coupling values of the limbic network (LN) (t = 3.727, P = 0.002) and frontoparietal network (FPN) (t = 2.708, P = 0.032) were significantly increased. Correlation analysis indicated that baseline VAS scores in FMS patients were weakly positively correlated with LN coupling values (r = 0.370, P = 0.016) and weakly negatively correlated with FPN coupling values (r = -0.388, P = 0.011). The baseline SC-FC coupling value of the FPN demonstrated significant predictive value for the short-term efficacy of rTMS (AUC = 0.751, P = 0.006).Conclusions FMS has impaired structural integration and compensatory SC-FC, which are associated with pain symptoms. The pre-treatment FPN SC-FC is a potential biomarker for rTMS efficacy, which could provide a reference for optimizing FMS treatment.
[Keywords] fibromyalgia syndrome；magnetic resonance imaging；repetitive transcranial magnetic stimulation；graph theory；structural-functional coupling；therapeutic effect；neuroimaging

XU Tong   ZHANG Xinran   SHI Guoji   WU Ting*  

Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

Corresponding author: WU T, E-mail: fsyy00598@njucm.edu.cn

Conflicts of interest   None.

Received  2025-11-18
Accepted  2026-03-19
DOI: 10.12015/issn.1674-8034.2026.04.001
Cite this article as: XU T, ZHANG X R, SHI G J, et al. Study on brain structure-function coupling and prediction of rTMS efficacy in fibromyalgia syndrome patients based on multimodal MRI[J]. Chin J Magn Reson Imaging, 2026, 17(4): 1-9. DOI:10.12015/issn.1674-8034.2026.04.001.

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