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All participants underwent resting\u2010state functional MRI. Independent component analysis was conducted to identify intrinsic brain networks and obtain key regions of interest. Dynamic causal modeling (DCM) was applied to further analyze the effective connectivity (EC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with SCI showed significantly reduced connectivity between the default mode network (DMN) and the salience network (SAN). DCM revealed that the posterior cingulate cortex (PCC) was a key upstream regulator, exerting enhanced inhibitory influence on the medial prefrontal cortex, bilateral insula, and bilateral inferior parietal lobule. Subgroup analyses revealed that complete SCI was associated with increased excitatory drive from the DMN to the SAN, but enhanced inhibitory influence in the reverse pathway compared to incomplete SCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PCC is a pivotal node in post\u2010SCI brain reorganization, suggesting it as a potential neuromodulation target. The bidirectional DMN\u2010SAN regulatory imbalance is closely related to SCI severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.70720","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T07:57:07Z","timestamp":1766735827000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effective Connectivity Alterations of Directed Brain Network in Pediatric Patients With Spinal Cord Injury"],"prefix":"10.1002","volume":"31","author":[{"given":"Yu","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University  Beijing China"},{"name":"Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics  Beijing 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