1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium.
Brain. 2015 Sep;138(Pt 9):2619-31. doi: 10.1093/brain/awv169. Epub 2015 Jun 27.
Despite advances in resting state functional magnetic resonance imaging investigations, clinicians remain with the challenge of how to implement this paradigm on an individualized basis. Here, we assessed the clinical relevance of resting state functional magnetic resonance imaging acquisitions in patients with disorders of consciousness by means of a systems-level approach. Three clinical centres collected data from 73 patients in minimally conscious state, vegetative state/unresponsive wakefulness syndrome and coma. The main analysis was performed on the data set coming from one centre (Liège) including 51 patients (26 minimally conscious state, 19 vegetative state/unresponsive wakefulness syndrome, six coma; 15 females; mean age 49 ± 18 years, range 11-87; 16 traumatic, 32 non-traumatic of which 13 anoxic, three mixed; 35 patients assessed >1 month post-insult) for whom the clinical diagnosis with the Coma Recovery Scale-Revised was congruent with positron emission tomography scanning. Group-level functional connectivity was investigated for the default mode, frontoparietal, salience, auditory, sensorimotor and visual networks using a multiple-seed correlation approach. Between-group inferential statistics and machine learning were used to identify each network's capacity to discriminate between patients in minimally conscious state and vegetative state/unresponsive wakefulness syndrome. Data collected from 22 patients scanned in two other centres (Salzburg: 10 minimally conscious state, five vegetative state/unresponsive wakefulness syndrome; New York: five minimally conscious state, one vegetative state/unresponsive wakefulness syndrome, one emerged from minimally conscious state) were used to validate the classification with the selected features. Coma Recovery Scale-Revised total scores correlated with key regions of each network reflecting their involvement in consciousness-related processes. All networks had a high discriminative capacity (>80%) for separating patients in a minimally conscious state and vegetative state/unresponsive wakefulness syndrome. Among them, the auditory network was ranked the most highly. The regions of the auditory network which were more functionally connected in patients in minimally conscious state compared to vegetative state/unresponsive wakefulness syndrome encompassed bilateral auditory and visual cortices. Connectivity values in these three regions discriminated congruently 20 of 22 independently assessed patients. Our findings point to the significance of preserved abilities for multisensory integration and top-down processing in minimal consciousness seemingly supported by auditory-visual crossmodal connectivity, and promote the clinical utility of the resting paradigm for single-patient diagnostics.
尽管静息态功能磁共振成像研究取得了进展，但临床医生仍然面临如何在个体化基础上实施这一范式的挑战。在这里，我们通过系统水平的方法评估了静息态功能磁共振成像在意识障碍患者中的临床相关性。三个临床中心从最小意识状态、植物状态/无反应觉醒综合征和昏迷的 73 名患者中收集数据。主要分析是在一个中心（列日）的数据集中进行的，该数据集包括 51 名患者（26 名最小意识状态，19 名植物状态/无反应觉醒综合征，6 名昏迷；15 名女性；平均年龄 49 ± 18 岁，范围 11-87；16 名创伤性，32 名非创伤性，其中 13 名缺氧性，3 名混合性；35 名患者在损伤后>1 个月进行评估），他们的临床诊断与正电子发射断层扫描一致。使用多种子相关方法研究默认模式、额顶叶、突显、听觉、感觉运动和视觉网络的组水平功能连接。使用组间推断统计学和机器学习来识别每个网络区分最小意识状态和植物状态/无反应觉醒综合征患者的能力。从另外两个中心（萨尔茨堡：10 名最小意识状态，5 名植物状态/无反应觉醒综合征；纽约：5 名最小意识状态，1 名植物状态/无反应觉醒综合征，1 名从最小意识状态中恢复）扫描的 22 名患者的数据用于验证使用选定特征的分类。昏迷恢复量表修订后的总评分与每个网络的关键区域相关，反映了它们在意识相关过程中的参与度。所有网络对分离最小意识状态和植物状态/无反应觉醒综合征患者的能力均较高（>80%）。其中，听觉网络排名最高。与植物状态/无反应觉醒综合征相比，在最小意识状态患者中功能连接更强的听觉网络区域包括双侧听觉和视觉皮层。这些三个区域的连接值一致地区分了 22 名独立评估患者中的 20 名。我们的发现表明，在最小意识状态中，多感觉整合和自上而下处理的保留能力具有重要意义，这似乎得到了听觉-视觉跨模态连接的支持，并促进了静息范式在单个患者诊断中的临床应用。
