Pathophysiology-driven neuroimaging: decoding brain injury in sepsis

Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction induced by sepsis, characterized by high mortality and frequent long-term cognitive impairment. Its pathogenesis involves multiple mechanisms, including endothelial activation, blood-brain barrier (BBB) disruption, neuroinflammation, and neurotransmitter imbalance, ultimately resulting in neuronal and glial injury. Recent advances in neuroimaging have provided new insights into the pathological features of SAE, while offering valuable tools for early diagnosis, prognostic stratification, and the identification of potential therapeutic targets. This Review summarizes recent advances in neuroimaging research in SAE, integrating clinical findings with pathophysiological and experimental evidence to delineate imaging phenotypes, elucidate underlying mechanisms, and highlight the translational potential of emerging imaging modalities.