Neural mechanisms of cough: insights from multimodal magnetic resonance imaging-a narrative review.

BACKGROUND AND

OBJECTIVE

Cough is an essential defensive reflex that plays a critical role in airway protection. Dysfunction of this reflex, often manifesting as chronic cough or cough hypersensitivity, involves complex alterations in both peripheral and central nervous systems. While previous studies primarily focused on brainstem-mediated reflexes, recent neuroimaging highlights the pivotal role of higher cortical areas in regulating both voluntary and involuntary cough. This review aims to comprehensively summarize the application of multimodal magnetic resonance imaging (MRI) in delineating these central mechanisms and identifying therapeutic targets.

METHODS

For this narrative review, we conducted a structured literature search using PubMed, Embase, and Web of Science to identify relevant studies published up to January 2026. Search terms included "cough", "chronic cough", "multimodal MRI", "structural MRI (sMRI)", "functional MRI (fMRI)", and "diffusion MRI (dMRI)". Relevant articles focusing on neural substrates of cough and neuroimaging-guided interventions were selected and synthesized.

KEY CONTENT AND FINDINGS: By integrating sMRI, fMRI, and dMRI, current research has delineated a dynamic cough-related neural network. Key hubs identified include the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and nucleus tractus solitarius (NTS). The review further describes mechanisms of central sensitization and neuroplasticity that may characterize refractory cough. Additionally, we explore how these imaging biomarkers can guide pharmacological and non-invasive interventions, such as transcranial direct current stimulation (tDCS).

CONCLUSIONS

Multimodal MRI facilitates a deeper understanding of the central functional alterations associated with cough dysfunction. Identification of specific imaging biomarkers provides reliable neuroimaging targets for novel diagnostic and therapeutic strategies, ultimately facilitating the development of precision medicine for patients with cough-related neurological disorders.