and background: Neuroimaging studies have increasingly found functional connectivity (FC) changes and structural cortical abnormalities in patients with post-traumatic anosmia (PTA). Training and repeated exposure to odorants lead to enhanced olfactory capability. This study is conducted to investigate the correlations between FC and cortical thickness on the olfaction-related regions of the brain in PTA after olfactory training (OT). Twenty-five PTA patients were randomly divided in three groups: (1) 9 control patients who did not receive any training, (2) 9 patients underwent classical OT by 4 fixed odors, and (3) 7 patients underwent modified OT coming across 4 sets of 4 different odors sequentially. Before and after the training period, all patients performed olfactory function tests, and magnetic resonance imaging (MRI). Sniffin' Sticks test was used to assess olfactory function. MRI data were analyzed using functional connectivity analysis and brain morphometry. Modified OT resulted in heightened activation in the medial orbitofrontal cortex and anterior cingulate cortex and increased FC between the piriform cortex (PIRC) and the caudate cortex. Conversely, classical OT induced increased activation in the insula cortex and greater FC between the PIRC and the pre-central gyrus. Furthermore, after OT, both training groups achieved significantly improved scores in the changes in brain connectivity associated with OT, which were attributable to anatomical measures. This study demonstrates that intensive olfactory training can enhance functional connectivity, and this improvement correlates with structural changes in the brain's olfactory processing areas.
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