Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
School of Communication & Information Engineering, Shanghai University, Shanghai, China.
CNS Neurosci Ther. 2024 Jun;30(6):e14787. doi: 10.1111/cns.14787.
The patient being minimally conscious state (MCS) may benefit from wake-up interventions aimed at improving quality of life and have a higher probability of recovering higher level of consciousness compared to patients with the unresponsive wakefulness syndrome (UWS). However, differentiation of the MCS and UWS poses challenge in clinical practice. This study aimed to explore glucose metabolic pattern (GMP) obtained from F-labeled-fluorodeoxyglucose positron emission tomography (F-FDG-PET) in distinguishing between UWS and MCS.
Fifty-seven patients with disorders of consciousness (21 cases of UWS and 36 cases of MCS) who had undergone repeated standardized Coma Recovery Scale-Revised (CRS-R) evaluations were enrolled in this prospective study. F-FDG-PET was carried out in all patients and healthy controls (HCs). Voxel-based scaled subprofile model/principal component analysis (SSM/PCA) was used to generate GMPs. The expression score of whole-brain GMP was obtained, and its diagnostic accuracy was compared with the standardized uptake value ratio (SUVR). The diagnostic efficiency was validated by one-year later clinical outcomes.
UWS-MCS GMP exhibited hypometabolism in the frontal-parietal cortex, along with hypermetabolism in the unilateral lentiform nucleus, putamen, and anterior cingulate gyrus. The UWS-MCS-GMP expression score was significantly higher in UWS compared to MCS patients (0.90 ± 0.85 vs. 0 ± 0.93, p < 0.001). UWS-MCS-GMP expression score achieved an area under the curve (AUC) of 0.77 to distinguish MCS from UWS, surpassing that of SUVR based on the frontoparietal cortex (AUC = 0.623). UWS-MCS-GMP expression score was significantly correlated with the CRS-R score (r = -0.45, p = 0.004) and accurately predicted the one-year outcome in 73.7% of patients.
UWS and MCS exhibit specific glucose metabolism patterns, the UWS-MCS-GMP expression score significantly distinguishes MCS from UWS, making SSM/PCA a potential diagnostic methods in clinical practice for individual patients.
处于最小意识状态（MCS）的患者可能受益于唤醒干预，以提高生活质量，并且与无反应觉醒综合征（UWS）患者相比，更有可能恢复更高水平的意识。然而，在临床实践中，区分 MCS 和 UWS 具有挑战性。本研究旨在探讨 F-标记氟脱氧葡萄糖正电子发射断层扫描（F-FDG-PET）获得的葡萄糖代谢模式（GMP）在区分 UWS 和 MCS 中的作用。
本前瞻性研究纳入了 57 例意识障碍患者（21 例 UWS 和 36 例 MCS），这些患者均接受了重复的标准化昏迷恢复量表修订版（CRS-R）评估。所有患者和健康对照者（HCs）均进行 F-FDG-PET 检查。采用基于体素的 scaled subprofile model/principal component analysis（SSM/PCA）生成 GMP。获得全脑 GMP 的表达评分，并比较其与标准化摄取值比（SUVR）的诊断准确性。通过一年后的临床结局验证诊断效率。
UWS-MCS GMP 在前额顶叶皮层表现出代谢低下，单侧豆状核、壳核和前扣带回呈代谢亢进。UWS-MCS-GMP 表达评分在 UWS 患者中明显高于 MCS 患者（0.90±0.85 与 0±0.93，p<0.001）。UWS-MCS-GMP 表达评分区分 MCS 和 UWS 的曲线下面积（AUC）为 0.77，优于基于额顶叶皮层的 SUVR（AUC=0.623）。UWS-MCS-GMP 表达评分与 CRS-R 评分显著相关（r=-0.45，p=0.004），并能准确预测 73.7%患者的一年结局。
UWS 和 MCS 表现出特定的葡萄糖代谢模式，UWS-MCS-GMP 表达评分可显著区分 MCS 和 UWS，使 SSM/PCA 成为临床实践中针对个体患者的潜在诊断方法。
