Almost three decades have passed since the first posttraumatic stress disorder (PTSD) neuroimaging study was published. Since then, the field of clinical neuroscience has made advancements in understanding the neural correlates of PTSD to create more efficacious treatment strategies. While gold-standard psychotherapy options are available, many patients do not respond to them, prematurely drop out, or never initiate treatment. Therefore, elucidating the neurobiological mechanisms that define the disorder can help guide clinician decision-making and develop individualized mechanisms-based treatment options. To this end, this narrative review highlights progress made in the last decade in adult and youth samples on three outstanding questions in PTSD research: (1) Which neural alterations serve as predisposing (pre-exposure) risk factors for PTSD development, and which are acquired (post-exposure) alterations? (2) Which neural alterations can predict treatment outcomes and define clinical improvement? and (3) Can neuroimaging measures be used to define brain-based biotypes of PTSD? While the studies highlighted in this review have made progress in answering the three questions, the field still has much to do before implementing these findings into clinical practice. Overall, to better answer these questions, we suggest that future neuroimaging studies of PTSD should (A) utilize prospective longitudinal designs, collecting brain measures before experiencing trauma and at multiple follow-up time points post-trauma, taking advantage of multi-site collaborations/consortiums; (B) collect two scans to explore changes in brain alterations from pre-to-post treatment and compare changes in neural activation between treatment groups, including longitudinal follow up assessments; and (C) replicate brain-based biotypes of PTSD. By synthesizing recent findings, this narrative review will pave the way for personalized treatment approaches grounded in neurobiological evidence.

自第一份创伤后应激障碍 (PTSD) 神经影像学研究发表以来，已经过去了近三十年。从那时起，临床神经科学领域在理解 PTSD 的神经相关性方面取得了进展，以制定更有效的治疗策略。虽然有黄金标准的心理治疗选择，但许多患者对这些治疗没有反应，过早退出，或从未开始治疗。因此，阐明定义该疾病的神经生物学机制可以帮助指导临床医生决策并开发基于个体化机制的治疗方案。为此，这篇叙述性综述强调了过去十年中成人和青少年样本在 PTSD 研究中三个突出问题上取得的进展：(1) 哪些神经改变是 PTSD 发展的诱发（暴露前）风险因素，哪些是获得性（暴露后）改变？ (2) 哪些神经改变可以预测治疗结果并定义临床改善？ (3) 神经影像学测量能否用于定义基于大脑的 PTSD 生物型？尽管本次综述中强调的研究在回答这三个问题方面取得了进展，但在将这些发现应用于临床实践之前，该领域仍有很多工作要做。总的来说，为了更好地回答这些问题，我们建议未来 PTSD 的神经影像学研究应该 (A) 利用前瞻性纵向设计，在经历创伤之前和创伤后多个随访时间点收集大脑测量数据，利用多站点协作/财团； (B) 收集两次扫描，探索治疗前后大脑变化的变化，并比较治疗组之间神经激活的变化，包括纵向随访评估； (C) 复制基于大脑的 PTSD 生物型。通过综合最近的发现，这篇叙述性综述将为基于神经生物学证据的个性化治疗方法铺平道路。