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Relationships with cognitive and sleep scores were assessed using partial correlations, stratified by group only when significant interaction effects were detected. Multiple comparisons were false discovery rate corrected (\n p<\/jats:italic>\n \u2009<\u20090.05). Classification model performance was evaluated using the area under the receiver operating characteristic curve (AUC). Model comparisons were performed using DeLong's tests (\u0394AUC) and stepwise likelihood ratio tests (LRT) to assess classification gain and the independent incremental contribution of each biomarker; all tests were two\u2010sided with\n \u03b1<\/jats:italic>\n \u2009=\u20090.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Compared to controls, insomnia patients showed significantly reduced BOLD\u2010CSF coupling (\u22120.18\u2009\u00b1\u20090.20 vs. \u22120.32\u2009\u00b1\u20090.17), indicating altered temporal coordination between neurovascular and CSF dynamics. ChP volume was significantly enlarged in the insomnia group (1.72%\u2009\u00b1\u20090.42% vs. 1.55%\u2009\u00b1\u20090.39% of total intracranial volume), potentially reflecting compensatory CSF production upregulation, inflammatory changes, or vascular remodeling. NBM volume was significantly reduced in insomnia patients (201.75\u2009\u00b1\u200917.66 vs. 217.47\u2009\u00b1\u200921.04\u2009mm\n 3<\/jats:sup>\n ), suggesting cholinergic system alterations. In contrast, the DTI\u2010ALPS index did not differ between groups (\n p<\/jats:italic>\n \u2009=\u20090.85). BOLD\u2010CSF coupling positively correlated with PSQI (\n r<\/jats:italic>\n \u2009=\u20090.34), ISI (\n r<\/jats:italic>\n \u2009=\u20090.41), and FSS (\n r<\/jats:italic>\n \u2009=\u20090.40); ChP volume positively correlated with ISI (\n r<\/jats:italic>\n \u2009=\u20090.32) and FSS (\n r<\/jats:italic>\n \u2009=\u20090.35) (all FDR\u2010corrected). A dataset consists of 74 participants (46 HC and 28 ID) were included, the four\u2010marker classification model achieved moderate performance (AUC\u2009=\u20090.785, accuracy\u2009=\u200971.9%).\n <\/jats:p>\n <\/jats:sec>\n \n Data Conclusion<\/jats:title>\n Multiple indirect neuroimaging markers potentially related to neurofluid dynamics were altered in middle\u2010aged and older women with chronic insomnia, except for DTI\u2010ALPS. These findings include altered neurovascular\u2010CSF coordination, ChP enlargement, and cholinergic system volume reduction.<\/jats:p>\n <\/jats:sec>\n \n Evidence Level<\/jats:title>\n 2.<\/jats:p>\n <\/jats:sec>\n \n Technical Efficacy<\/jats:title>\n Stage 2.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jmri.70417","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T01:14:48Z","timestamp":1784596488000},"page":"1115-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Altered Neurofluid Dynamics Markers in Middle\u2010Aged and Older Women With Insomnia: A Multiparametric\n MR<\/scp>\n Neuroimaging Study"],"prefix":"10.1002","volume":"64","author":[{"given":"Ruisi","family":"Wang","sequence":"first","affiliation":[{"name":"Centre for Cognitive and Brain Sciences University of Macau Macau SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2902-9179","authenticated-orcid":false,"given":"Kun","family":"Wang","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College Guangzhou University of Chinese Medicine Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4799-2484","authenticated-orcid":false,"given":"Qiwei","family":"Guo","sequence":"additional","affiliation":[{"name":"Centre for Cognitive and Brain Sciences University of Macau Macau SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chentat","family":"Leong","sequence":"additional","affiliation":[{"name":"Centre for Cognitive and Brain Sciences University of Macau Macau SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglin","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinzhe","family":"Zeng","sequence":"additional","affiliation":[{"name":"Centre for Cognitive and Brain Sciences University of Macau Macau SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Radiology, Athinoula A. 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