Objective In this study, we investigated the correlation between the scores for different Liebowitz Social Anxiety Scale (LSAS) subscale models and the metabolic activity in specific regions of the brain using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) (¹⁸F-FDG PET), thereby improving the understanding of the neurobiological characteristics of social anxiety.

Methods A total of 39 cognitively normal participants (29 men and 10 women, aged 30-63 years) were enrolled. All participants underwent LSAS assessment and brain ¹⁸F-FDG PET scanning. Correlations between metabolic activities in various brain regions and scores from the different LSAS subscales were analyzed accordingly.

Results LSAS subscale scores were significantly correlated with metabolic activity in specific brain regions. In the Safren model, the score for the observation by others subscale was positively correlated with the left fusiform gyrus (P < 0.001, false discovery rate FDR-corrected) and the left caudate tail (P < 0.001, FDR-corrected), suggesting a close association between mood states related to observation by others and the metabolic activity in these regions. In the Baker model, the score for the eating and drinking subscale was negatively correlated with the right precuneus (P < 0.001, FDR-corrected), while the score for the assertiveness subscale was positively correlated with the left caudate nucleus (P < 0.001, FDR-corrected). These findings revealed the complex associative patterns between various mood and behavioral dimensions and metabolic activities in specific brain regions.

Conclusion Social anxiety symptoms are closely associated with metabolic changes in specific brain regions, including the left insula, left caudate tail, and right precuneus. Moreover, different social situations activate distinct brain regions. Compared with individuals with social anxiety disorder, normal individuals exhibit involvement of fewer brain regions when experiencing social anxiety. These findings provide new experimental evidence for understanding the neural mechanisms underlying social anxiety.