Disorder of consciousness related pattern could distinguish minimally conscious state from unresponsive wakefulness syndrome: A F-18-FDG-PET study

• Published in: Brain research bulletin Vol. 215; p. 111023
• Main Authors: He, Zhijie, Lu, Rongrong, Ge, Jingjie, Guan, Yihui, Chen, Ying, Liu, Gang, Xie, Hongyu, Bai, Yulong, Wu, Yi, Wu, Junfa, Jia, Jie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024; Elsevier
• Subjects: Adult; Aged; Brain - diagnostic imaging; Brain metabolic pattern; Consciousness Disorders - diagnostic imaging; Diagnosis, Differential; Disorder of consciousness; F-18-fluorodeoxyglucose positron emission tomography; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Minimally conscious state; Persistent Vegetative State - diagnostic imaging; Positron-Emission Tomography - methods; Unresponsive wakefulness syndrome; Wakefulness - physiology; Brain metabolic pattern; Unresponsive wakefulness syndrome; Minimally conscious state; F-18-fluorodeoxyglucose positron emission tomography; Disorder of consciousness
• ISSN: 0361-9230; 1873-2747; 1873-2747
• DOI: 10.1016/j.brainresbull.2024.111023

Accurate evaluation of level of disorder of consciousness (DOC) is clinically challenging. This study aimed to establish a distinctive DOC-related pattern (DOCRP) for assessing disease severity and distinguishing unresponsive wakefulness syndrome (UWS) from minimally conscious state (MCS). Fifteen patients with DOC and eighteen health subjects with F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET) were enrolled in this study. All patients were assessed by Coma Recovery Scale-Revised (CRS-R) and all individuals were randomly divided into two cohorts (Cohort A and B). DOCRP was identified in Cohort A and subsequently validated in Cohort B and A+B. We also assessed the discriminatory power of DOCRP between MCS and UWS. The DOCRP was characterized bilaterally by relatively decreased metabolism in the medial and lateral frontal lobes, parieto-temporal lobes, cingulate gyrus and caudate, associated with relatively increased metabolism in the cerebellum and brainstem. DOCRP expression exhibited high accuracy in differentiating DOC patients from controls (P<0.0001, AUC=1.000), and furthermore could effectively distinguish MCS from UWS (P=0.037, AUC=0.821, sensitivity: 85.7 %, specificity: 75.0 %). Particularly in the subgroup of DOC patients survived global hypoxic-ischemic brain injury, DOCRP expression exhibited even better discriminatory power between MCS and UWS (P=0.046, AUC=1.000). DOCRP might serve as an objective biomarker in distinguishing between UWS and MCS, especially in patients survived global hypoxic-ischemic brain injury. ChiCTR2300073717 (Chinese clinical trial registry site, http://www.chictr.org) •In this study, we innovatively defined a disease-specific brain metabolic network in patients with disorder of consciousness (DOC).•The metabolic network activity demonstrated high comparability and reproducibility in DOC patients and exhibited high accuracy in separating unresponsive wakefulness syndrome (UWS) from minimally conscious state (MCS).•The discriminatory power of the metabolic network acitivty was particularly well in the subgroup of patients survived global hypoxic-ischemic brain injury.•The results suggested that metabolic network activity could serve as an objective marker for evaluating the consciousness level in clinical practice.