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This is partly due to differential cortico-striato-thalamo-cortical networks (CSTC) engagement across stimulation in relevant anatomical regions. This study compared the structural and functional connectivity profiles of three relevant anatomical-regions that have also served as target for DBS in different centers for trOCD: the nucleus accumbens\/anterior-limb of the internal-capsule (NAc\/ALIC), the medial forebrain bundle (MFB), and the anteromedial subthalamic nucleus (amSTN). We analysed in a retrospective, observational, single-center cohort the structural connectivity on patient-specific space, using structural and diffusion MRI data from 22 trOCD patients treated with NAc\/ALIC DBS at the University Hospital Cologne. For this end, Whole-brain probabilistic-tractography using single-shell-three-tissue constrained-spherical-deconvolution was applied to reconstruct patient-specific structural connectivity matrices. From whole-brain tractograms, target-specific streamline subsets were selected using ROI-based inclusion criteria using 2\u2009mm radius spheric stereotactic ROIs representing clinically relevant trOCD-DBS target regions. Afterwards, Structural connectivity matrices were extracted using Spherical-deconvolution informed filtering of tractograms (SIFT) streamline count, fractional anisotropy (FA), and mean diffusivity (MD) across 13 cortico-subcortical regions implicated in OCD pathophysiology. Thereafter, we characterized each target\u2019s connectivity to key OCD functional networks derived from meta-analytic functional connectivity maps. NAc\/ALIC demonstrated stronger structural fronto-limbic connectivity: medial-orbitofrontal cortex, anterior-cingulate, insula, and accumbens (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), associated with the affect (AN), salience (SN), default-mode (DMN), and reward-motivation (RMN) networks anatomical hubs. The MFB predominantly connected with reward-related regions: pallidum and rostral-middle-frontal cortex (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). The amSTN showed to be mainly connected to SN and the cognitive\/motor control network (CMCN): precentral and paracentral gyri (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). These exploratory findings suggest that clinically relevant trOCD-DBS targets may engage distinct but partially overlapping tractography derived structural networks and meta-analytic functional networks. The observed connectivity profiles may help generate hypotheses about symptom-specific networks for future DBS planning. Overall, these results support the proof-of-concept value of patient-specific probabilistic tractography in trOCD. However, prospective validation in independent, multicentric trials remains necessary before clinical translation.\n                  <\/jats:p>","DOI":"10.1038\/s41398-026-04441-4","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:38:31Z","timestamp":1790098711000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-specific structural connectomic differences of deep brain stimulation targets in treatment-resistant obsessive-compulsive disorder patients"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2376-1542","authenticated-orcid":false,"given":"Rene","family":"Marquez-Franco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Ruelas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Lou\u00e7\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4877-0916","authenticated-orcid":false,"given":"Rabea","family":"Schmahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1tima Ximena","family":"Cid Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Heiden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4719-5293","authenticated-orcid":false,"given":"Jens","family":"Kuhn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Koy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5274-7929","authenticated-orcid":false,"given":"Veerle","family":"Visser-Vandewalle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2596-7301","authenticated-orcid":false,"given":"Pablo","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"4441_CR1","doi-asserted-by":"crossref","unstructured":"Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG et al. 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