Department of Radiology, Seventh Medical Center of Chinese, PLA General Hospital, No.5 Nanmencang, Dongcheng District, Beijing, 100700, China.
Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, No.5 Zhongguancun South Street, Haidian District, Beijing, 100081, China.
Neuroradiology. 2022 Jul;64(7):1391-1399. doi: 10.1007/s00234-022-02911-2. Epub 2022 Feb 2.
It is always challenging to correctly differentiate between minimally conscious state (MCS) and vegetative state/unresponsive wakefulness syndrome (VS/UWS) among disorders of consciousness (DOC) patients. However, the underlying neural mechanisms of awareness identification remain incompletely understood.
Using regional homogeneity (ReHo) analysis, we evaluated how regional connectivity of brain regions is disrupted in MCS and VS/UWS patients. Resting-state functional magnetic resonance imaging was conducted in 14 MCS patients, 25 VS/UWS patients, and 30 age-matched healthy individuals.
We found that MCS and VS/UWS patients demonstrated DOC-dependent reduced ReHo within widespread brain regions including posterior cingulate cortices (PCC), medial prefrontal cortices (mPFC), and bilateral fronto-parieto-temporal cortices and showed increased ReHo in limbic structures. Moreover, a positive correlation between Coma Recovery Scale-Revised (CRS-R) total scores and reduced ReHo in the left precuneus was observed in VS/UWS patients, despite the linear trend was not found in MCS patients. In addition, ReHo were also observed reduced in three mainly intrinsic connectivity networks (ICNs), including default mode network (DMN), executive control network (ECN), and salience network (SN). Notably, as the clinical symptoms of consciousness disorders worsen from MCS to VS/UWS, ReHo in dorsal DMN, left ECN, and posterior SN became significantly reduced.
These findings make a further understanding of the underlying neural mechanism of regional connectivity among DOC patients and provide additional neuroimaging-based biomarkers for the clinical diagnosis of MCS and VS/UWS patients.
在意识障碍（DOC）患者中，正确区分最小意识状态（MCS）和植物状态/无反应觉醒综合征（VS/UWS）一直具有挑战性。然而，意识识别的潜在神经机制仍不完全清楚。
我们使用局部一致性（ReHo）分析来评估 MCS 和 VS/UWS 患者的脑区连接中断情况。对 14 名 MCS 患者、25 名 VS/UWS 患者和 30 名年龄匹配的健康个体进行了静息态功能磁共振成像。
我们发现 MCS 和 VS/UWS 患者在广泛的脑区（包括后扣带回皮质（PCC）、内侧前额叶皮质（mPFC）以及双侧额顶颞叶皮质）中表现出与 DOC 相关的降低的 ReHo，并在边缘结构中表现出增加的 ReHo。此外，在 VS/UWS 患者中，CRS-R 总评分与左楔前叶的 ReHo 呈正相关，尽管在 MCS 患者中没有发现线性趋势。此外，还观察到三个主要的内在连接网络（ICNs）中的 ReHo 降低，包括默认模式网络（DMN）、执行控制网络（ECN）和突显网络（SN）。值得注意的是，随着意识障碍从 MCS 向 VS/UWS 的临床症状恶化，背侧 DMN、左侧 ECN 和后 SN 的 ReHo 显著降低。
这些发现进一步了解了 DOC 患者之间区域连接的潜在神经机制，并为 MCS 和 VS/UWS 患者的临床诊断提供了额外的基于神经影像学的生物标志物。
