Multimodal neuroimaging of alcohol use: from acute neurochemical effects to chronic brain network reorganization and precision treatment targets.
Source: PubMed, NCBI / U.S. National Library of Medicine
Alcohol use and alcohol use disorder (AUD) remain among the leading causes of preventable morbidity and mortality worldwide, yet the mechanisms by which alcohol alters brain structure and function across the lifespan are only partially understood. Over recent decades, multimodal neuroimaging has provided key insights into the acute neurochemical and hemodynamic effects of alcohol, the neuroadaptations associated with sustained exposure, and the circuits that mediate vulnerability, progression, and relapse. In this narrative review, we integrate evidence from structural and diffusion MRI, task-based and resting-state fMRI, magnetic resonance spectroscopy, perfusion and metabolic techniques (arterial spin labeling, perfusion SPECT, FDG PET, andO PET), and molecular PET/SPECT targeting dopaminergic and non-dopaminergic systems. Acute alcohol effects include regionally specific changes in cerebral blood flow and metabolism, perturbations in sensory processing and cognitive control networks, and rapid modulation of dopaminergic, GABAergic, glutamatergic, and opioid signaling, with transient neuroimmune changes. Chronic exposure is associated with macro- and microstructural injury, large-scale network reorganization, and persistent molecular abnormalities in reward, salience, and executive control circuits, with links to craving severity and relapse risk, including heterogeneous neuroimmune findings and reduced synaptic integrity. We also highlight adolescent alcohol use, where exp
Abstract
Alcohol use and alcohol use disorder (AUD) remain among the leading causes of preventable morbidity and mortality worldwide, yet the mechanisms by which alcohol alters brain structure and function across the lifespan are only partially understood. Over recent decades, multimodal neuroimaging has provided key insights into the acute neurochemical and hemodynamic effects of alcohol, the neuroadaptations associated with sustained exposure, and the circuits that mediate vulnerability, progression, and relapse. In this narrative review, we integrate evidence from structural and diffusion MRI, task-based and resting-state fMRI, magnetic resonance spectroscopy, perfusion and metabolic techniques (arterial spin labeling, perfusion SPECT, FDG PET, andO PET), and molecular PET/SPECT targeting dopaminergic and non-dopaminergic systems. Acute alcohol effects include regionally specific changes in cerebral blood flow and metabolism, perturbations in sensory processing and cognitive control networks, and rapid modulation of dopaminergic, GABAergic, glutamatergic, and opioid signaling, with transient neuroimmune changes. Chronic exposure is associated with macro- and microstructural injury, large-scale network reorganization, and persistent molecular abnormalities in reward, salience, and executive control circuits, with links to craving severity and relapse risk, including heterogeneous neuroimmune findings and reduced synaptic integrity. We also highlight adolescent alcohol use, where exposure during ongoing neurodevelopment is associated with deviations in cortical and white-matter maturation and altered task-related brain responses, with potential lasting effects on connectivity and cognition. Finally, we summarize characteristic imaging patterns of alcohol-related neurological syndromes, highlight sex-related differences, review imaging markers of vulnerability and prognosis (familial risk, genetic variation, and predictors of treatment response), and outline priorities for precision medicine in AUD, emphasizing longitudinal multimodal designs, harmonization, and the development of validated molecular targets and imaging-guided interventions.