Disorder of consciousness: Structural integrity of brain networks for the clinical assessment

Author:

Medina Carrion Jean Paul1ORCID,Stanziano Mario12,D'Incerti Ludovico13,Sattin Davide4,Palermo Sara15,Ferraro Stefania16ORCID,Sebastiano Davide Rossi7ORCID,Leonardi Matilde8,Bruzzone Maria Grazia1,Rosazza Cristina19,Nigri Anna1ORCID

Affiliation:

1. Diagnostic and Technology Department, Neuroradiology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy

2. Neurosciences Department “Rita Levi Montalcini” University of Turin Turin Italy

3. Radiology Unit Children's Hospital A. Meyer–University of Florence Florence Italy

4. IRCCS Istituti Clinici Scientifici Maugeri di Milano Milan Italy

5. Department of Psychology University of Turin Turin Italy

6. School of Life Science and Technology, MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Chengdu China

7. Department of Neurophysiology and Diagnostic, Epileptology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy

8. Neurology, Public Health, Disability Unit Fondazione IRCCS Istituto Neurologico Carlo Besta

9. Department of Humanistic Studies University of Urbino Carlo Bo Urbino Italy

Abstract

AbstractAimWhen studying brain networks in patients with Disorders of Consciousness (DoC), it is important to evaluate the structural integrity of networks in addition to their functional activity. Here, we investigated whether structural MRI, together with clinical variables, can be useful for diagnostic purposes and whether a quantitative analysis is feasible in a group of chronic DoC patients.MethodsWe studied 109 chronic patients with DoC and emerged from DoC with structural MRI: 65 in vegetative state/unresponsive wakefulness state (VS/UWS), 34 in minimally conscious state (MCS), and 10 with severe disability. MRI data were analyzed through qualitative and quantitative approaches.ResultsThe qualitative MRI analysis outperformed the quantitative one, which resulted to be hardly feasible in chronic DoC patients. The results of the qualitative approach showed that the structural integrity of HighOrder networks, altogether, had better diagnostic accuracy than LowOrder networks, particularly when the model included clinical variables (AUC = 0.83). Diagnostic differences between VS/UWS and MCS were stronger in anoxic etiology than vascular and traumatic etiology. MRI data of all LowOrder and HighOrder networks correlated with the clinical score. The integrity of the left hemisphere was associated with a better clinical status.ConclusionsStructural integrity of brain networks is sensitive to clinical severity. When patients are chronic, the qualitative analysis of MRI data is indicated.

Funder

Ministero della Salute

Publisher

Wiley

Subject

Neurology (clinical),General Neuroscience

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