Cortical morphology of chronic users of codeine-containing cough syrups: association with sulcal depth, gyrification, and cortical thickness

  • Meng Li
  • Kelei Hua
  • Shumei Li
  • Changhong Li
  • Wenfeng Zhan
  • Hua Wen
  • Xiaofen Ma
  • Junzhang Tian
  • Guihua JiangEmail author
Magnetic Resonance



The study aimed to explore the effects of codeine-containing cough syrup (CCS) exposure on cortical morphology and the relationship between cortical characteristics and CCS dependence.


Cortical morphometry based on Computational Anatomy Toolbox (CAT12) was used to compare changes in sulcal depth, gyrification, and cortical thickness of the cerebral cortex from 40 CCS users and 40 healthy controls (HCs) with two-sample t tests (p < 0.05, multiple comparison corrected). Relationships between abnormal cortical morphological changes and the duration of CCS use, impulsivity traits, and age of first use were investigated with correlation analysis (p < 0.05, uncorrected).


CCS users exhibited significantly increased sulcal depth in the bilateral insula, bilateral lingual, bilateral superior frontal, right precuneus, and right middle frontal regions; increased gyrification in the right precentral cortex; and increased cortical thickness in the bilateral precentral, bilateral precuneus, and right superior temporal cortices compared to HCs. In addition, we found significant correlations between the bilateral insula, right superior frontal cortex, and right precentral gyrus and Barratt Impulsiveness Scale (BIS) total scores.


Chronic CCS abuse may be associated with aberrant sulcal depth, gyrification, and cortical thickness. These morphological changes might serve as an underlying neurobiological mechanism of impulsive behavior in the CCS users.

Key Points

• Cortical morphological changes were detected in CCS users.

• Increased sulcal depth, gyrification, and cortical thickness of some regions were found in the CCS users.

• Positive correlations between cortical morphological changes and BIS total scores were identified.


Codeine Cough Cerebral cortex Frontal lobe Impulsive behavior 



Barratt Impulsiveness Scale


Computational Anatomy Toolbox


Codeine-containing cough syrup


Healthy controls






Middle frontal cortex


Projection-based thickness




Prefrontal cortex


Precentral gyrus


Superior frontal cortex


Superior temporal cortex


Total intracranial volume



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Guihua Jiang.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.


• prospective

• cross-sectional study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Medical ImagingGuangdong Second Provincial General HospitalGuangzhouPeople’s Republic of China

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