Conventional structural magnetic resonance imaging in differentiating chronic disorders of consciousness

Abstract

BACKGROUND: Differential diagnosis of chronic disorders of consciousness remains one of the most difficult problems even for experienced clinicians.

AIM: To evaluate the inter-expert consistency and capacity of the researcher-developed structural scale based on magnetic resonance imaging to differentiate chronic disorders of consciousness, named, DOC-MRIDS, on a larger sample of patients.

MATERIALS AND METHODS: Sixty patients with a clinically stable status diagnosed with consciousness disorders (vegetative state, n=32; minimally conscious state, n=28) were enrolled. The revised coma recovery scale (CRS-R) was included in the clinical assessment. All patients underwent structural magnetic resonance imaging with 3.0-T Siemens scanners including T2 and T1 sequences. Structural changes were assessed using the DOC-MRIDS scale and included the following features: diffuse cortical atrophy, ventricular enlargement, gyri dilatation, leukoaraiosis, brainstem and/or thalamic degeneration, corpus callosum degeneration, and focal corpus callosum lesions. A total score was calculated. Magnetic resonance imaging data were analyzed by three neuroradiologists, and inter-observer agreement (Krippendorf’s alpha) was assessed.

RESULTS: A high inter-examiner agreement of the DOC-MRIDS scale score was found, with α=0.806 (95% confidence interval 0.757–0.849). The vegetative state group had a higher DOC-MRIDS score than the minimally conscious state group (p <0.005). A negative correlation was obtained between CRS-R and DOC-MRIDS scale scores (ρ=–0.457, p <0.0001), individual clinical scale domains, and magnetic resonance imaging features.

CONCLUSION: When assessing structural changes in patients with chronic consciousness disorders, the use of the DOC-MRIDS scale helps differentiate the type of such disorders with sufficient specificity, sensitivity, and inter-rater agreement. This scale can be used in clinical practice as an additional differential diagnostic tool.

Keywords

magnetic resonance imaging / structural assessment / chronic disorders of consciousness / unresponsive wakefulness syndrome / minimally conscious state / differential diagnosis

References

[1] Koch C, Massimini M, Boly M, Tononi G. Neural correlates of consciousness: progress and problems. Nat Rev Neurosci. 2016;17(5):307–321. doi: 10.1038/nrn.2016.22

[2] Koch C., Massimini M., Boly M., Tononi G. Neural correlates of consciousness: progress and problems // Nat Rev Neurosci. 2016. Vol. 17, N 5. P. 307–321. doi: 10.1038/nrn.2016.22

[3] Koch C, Massimini M, Boly M, Tononi G. Neural correlates of consciousness: progress and problems. Nat Rev Neurosci. 2016;17(5):307–321. doi: 10.1038/nrn.2016.22

[4] Monti MM, Laureys S, Owen AM. The vegetative state. BMJ. 2010;341:376–385. doi: 10.1136/bmj.c3765

[5] Monti M.M., Laureys S., Owen A.M. The vegetative state // BMJ. 2010. Vol. 341. P. 376–385. doi: 10.1136/bmj.c3765

[6] Monti MM, Laureys S, Owen AM. The vegetative state. BMJ. 2010;341:376–385. doi: 10.1136/bmj.c3765

[7] Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: Definition and diagnostic criteria. Neurology. 2002;58(3):349–353. doi: 10.1212/wnl.58.3.349

[8] Giacino J.T., Ashwal S., Childs N., et al. The minimally conscious state: Definition and diagnostic criteria // Neurology. 2002. Vol. 58, N 3. Р. 349–353. doi: 10.1212/wnl.58.3.349

[9] Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: Definition and diagnostic criteria. Neurology. 2002;58(3):349–353. doi: 10.1212/wnl.58.3.349

[10] Belkin AA, Aleksandrova EV, Akhutina TV, et al. Chronic Disorders of Consciousness: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”. Annals of critical care. 2023;(3):7–42. doi: 10.21320/1818-474X-2023-3-7-42

[11] Белкин А.А., Александрова Е.В., Ахутина Т.В., и др. Хронические нарушения сознания: клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов» // Вестник интенсивной терапии имени А.И. Салтанова. 2023. № 3. C. 7–42. doi: 10.21320/1818-474X-2023-3-7-42

[12] Belkin AA, Aleksandrova EV, Akhutina TV, et al. Chronic Disorders of Consciousness: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”. Annals of critical care. 2023;(3):7–42. doi: 10.21320/1818-474X-2023-3-7-42

[13] Giacino JT. The vegetative and minimally conscious states: Consensus-based criteria for establishing diagnosis and prognosis. Neurorehabilitation. 2004;19(4):293–298. doi: 10.3233/NRE-2004-19405

[14] Giacino J.T. The vegetative and minimally conscious states: Consensus-based criteria for establishing diagnosis and prognosis // Neurorehabilitation. 2004. Vol. 19, N 4. P. 293–298. doi: 10.3233/NRE-2004-19405

[15] Giacino JT. The vegetative and minimally conscious states: Consensus-based criteria for establishing diagnosis and prognosis. Neurorehabilitation. 2004;19(4):293–298. doi: 10.3233/NRE-2004-19405

[16] Seel RT, Sherer M, et al. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010;91(12):1795–1813. doi: 10.1016/j.apmr.2010.07.218

[17] Seel R.T., Sherer M., et al. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research // Arch Phys Med Rehabil. 2010. Vol. 91, N 12. P. 1795–1813. doi: 10.1016/j.apmr.2010.07.218

[18] Seel RT, Sherer M, et al. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010;91(12):1795–1813. doi: 10.1016/j.apmr.2010.07.218

[19] Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009;(9):35–40. doi: 10.1186/1471-2377-9-35

[20] Schnakers C., Vanhaudenhuyse A., Giacino J., et al. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment // BMC Neurol. 2009. N 9. P. 35–40. doi: 10.1186/1471-2377-9-35

[21] Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009;(9):35–40. doi: 10.1186/1471-2377-9-35

[22] Stender J, Gosseries O, Bruno M, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: A clinical validation study. Lancet. 2014;384(9942):514–522. doi: 10.1016/S0140-6736(14)60042-8

[23] Stender J., Gosseries O., Bruno M., et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: A clinical validation study // Lancet. 2014. Vol. 384, N 9942. P. 514–522. doi: 10.1016/S0140-6736(14)60042-8

[24] Stender J, Gosseries O, Bruno M, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: A clinical validation study. Lancet. 2014;384(9942):514–522. doi: 10.1016/S0140-6736(14)60042-8

[25] Monti M, Vanhaudenhuyse A, Coleman M, et al. Willful modulation of brain activity in disorders of consciousness. N. Engl. J. Med. 2010;362(7):579–589. doi: 10.1056/NEJMoa0905370

[26] Monti M., Vanhaudenhuyse A., Coleman M., et. al. Willful modulation of brain activity in disorders of consciousness // N. Engl. J. Med. 2010. Vol. 362, N 7. P. 579–589. doi: 10.1056/NEJMoa0905370

[27] Monti M, Vanhaudenhuyse A, Coleman M, et al. Willful modulation of brain activity in disorders of consciousness. N. Engl. J. Med. 2010;362(7):579–589. doi: 10.1056/NEJMoa0905370

[28] Crone J, Bio B, Vespa P, et. al. Restoration of thalamo-cortical connectivity after brain injury: Recovery of consciousness, complex behavior, or passage of time. J. Neurosci. Res. 2018;96(4):671–687. doi: 10.1002/jnr.24115

[29] Crone J., Bio B., Vespa P., et. al. Restoration of thalamo-cortical connectivity after brain injury: Recovery of consciousness, complex behavior, or passage of time // J. Neurosci. Res. 2018. Vol. 96, N 4. P. 671–687. doi: 10.1002/jnr.24115

[30] Crone J, Bio B, Vespa P, et. al. Restoration of thalamo-cortical connectivity after brain injury: Recovery of consciousness, complex behavior, or passage of time. J. Neurosci. Res. 2018;96(4):671–687. doi: 10.1002/jnr.24115

[31] Demertzi A, Antonopoulos G, Heine L, et al. Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients. Brain. 2015;138(9):2619–2631. doi: 10.1093/brain/awv169

[32] Demertzi A., Antonopoulos G., Heine L., et al. Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients // Brain. 2015. Vol. 138, N 9. P. 2619–2631. doi: 10.1093/brain/awv169

[33] Demertzi A, Antonopoulos G, Heine L, et al. Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients. Brain. 2015;138(9):2619–2631. doi: 10.1093/brain/awv169

[34] Lutkenhoff E, Chiang J, Tshibanda L, et al. Thalamic and extrathalamic mechanisms of consciousness after severe brain injury. Ann. Neurol. 2015;78(1):68–76. doi: 10.1002/ana.24423

[35] Lutkenhoff E., Chiang J., Tshibanda L., et al. Thalamic and extrathalamic mechanisms of consciousness after severe brain injury // Ann. Neurol. 2015. Vol. 78, N 1. P. 68–76. doi: 10.1002/ana.24423

[36] Lutkenhoff E, Chiang J, Tshibanda L, et al. Thalamic and extrathalamic mechanisms of consciousness after severe brain injury. Ann. Neurol. 2015;78(1):68–76. doi: 10.1002/ana.24423

[37] Guldenmund P, Soddu A, Baquero K, et al. Structural brain injury in patients with disorders of consciousness: A voxel-based morphometry study. Brain Inj. 2016;30(3):343–352. doi: 10.3109/02699052.2015.1118765

[38] Guldenmund P., Soddu A., Baquero K., et al. Structural brain injury in patients with disorders of consciousness: A voxel-based morphometry study // Brain Inj. 2016. Vol. 30, N 3. P. 343–352. doi: 10.3109/02699052.2015.1118765

[39] Guldenmund P, Soddu A, Baquero K, et al. Structural brain injury in patients with disorders of consciousness: A voxel-based morphometry study. Brain Inj. 2016;30(3):343–352. doi: 10.3109/02699052.2015.1118765

[40] Annen J, Frasso G, Crone J, et al. Regional brain volumetry and brain function in severely brain-injured patients. Ann. Neurol. 2018;83(4):842–853. doi: 10.1002/ana.25214

[41] Annen J., Frasso G., Crone J., et al. Regional brain volumetry and brain function in severely brain-injured patients // Ann. Neurol. 2018. Vol. 83, N 4. P. 842–853. doi: 10.1002/ana.25214

[42] Annen J, Frasso G, Crone J, et al. Regional brain volumetry and brain function in severely brain-injured patients. Ann. Neurol. 2018;83(4):842–853. doi: 10.1002/ana.25214

[43] Morozova SN, Kremneva EI, Sergeev DV, et al. Conventional Structural Magnetic Resonance Imaging in Differentiating Chronic Disorders of Consciousness. Brain Sci. 2018;8(8):144–155. doi: 10.3390/brainsci8080144

[44] Morozova S.N., Kremneva E.I., Sergeev D.V., et al. Conventional Structural Magnetic Resonance Imaging in Differentiating Chronic Disorders of Consciousness // Brain Sci. 2018. Vol. 8, N 8. P. 144–155. doi: 10.3390/brainsci8080144

[45] Morozova SN, Kremneva EI, Sergeev DV, et al. Conventional Structural Magnetic Resonance Imaging in Differentiating Chronic Disorders of Consciousness. Brain Sci. 2018;8(8):144–155. doi: 10.3390/brainsci8080144

[46] Legostaeva LA, Mochalova EG, Suponeva NA, et al. Difficulties in evaluation of chronic disorders of consciousness: approaches to clinical assessment and instrumental studies. Russian Journal of Anesthesiology and Reanimatology. 2017;62(6):449–456. EDN: YPLNJY doi: 10.18821/0201-7563-2017-62-6-449-456

[47] Легостаева Л.А., Мочалова Е.Г., Супонева Н.А., и др. Сложности клинической диагностики хронических нарушений сознания и рекомендации по клинико-инструментальной оценке пациентов после их выхода из комы // Анестезиология и реаниматология. 2017. Т. 62, № 6. C. 449–456. EDN: YPLNJY doi: 10.18821/0201-7563-2017-62-6-449-456

[48] Legostaeva LA, Mochalova EG, Suponeva NA, et al. Difficulties in evaluation of chronic disorders of consciousness: approaches to clinical assessment and instrumental studies. Russian Journal of Anesthesiology and Reanimatology. 2017;62(6):449–456. EDN: YPLNJY doi: 10.18821/0201-7563-2017-62-6-449-456

[49] Solovyeva PI, Sinkin МV, Talypov АE, et al. Clinical assessment of patients with chronic disorders of consciousness by different medical specialists. Annals of Clinical and Experimental Neurology. 2022;16(2):44–49. doi: 10.54101/ACEN.2022.2.5

[50] Соловьева П.И., Синкин М.В., Талыпов А.Э., и др. Клиническая оценка пациентов с хроническим нарушением сознания врачами разных специальностей // Анналы клинической и экспериментальной неврологии. 2022. Т. 16, № 2. C. 44–49. doi: 10.54101/ACEN.2022.2.5

[51] Solovyeva PI, Sinkin МV, Talypov АE, et al. Clinical assessment of patients with chronic disorders of consciousness by different medical specialists. Annals of Clinical and Experimental Neurology. 2022;16(2):44–49. doi: 10.54101/ACEN.2022.2.5

[52] Medina JP, Nigri A, Stanziano M, et al. Resting-State fMRI in Chronic Patients with Disorders of Consciousness: The Role of Lower-Order Networks for Clinical Assessment. Brain Sci. 2022;12(3):355–374. doi: 10.3390/brainsci12030355

[53] Medina J.P., Nigri A., Stanziano M., et al. Resting-State fMRI in Chronic Patients with Disorders of Consciousness: The Role of Lower-Order Networks for Clinical Assessment // Brain Sci. 2022. Vol. 12, N 3. P. 355–374. doi: 10.3390/brainsci12030355

[54] Medina JP, Nigri A, Stanziano M, et al. Resting-State fMRI in Chronic Patients with Disorders of Consciousness: The Role of Lower-Order Networks for Clinical Assessment. Brain Sci. 2022;12(3):355–374. doi: 10.3390/brainsci12030355

[55] Rohaut B, Doyle KW, Reynolds AS, et al. Deep structural brain lesions associated with consciousness impairment early after hemorrhagic stroke. Sci Rep. 2019;9(1):4174. doi: 10.1038/s41598-019-41042-2

[56] Rohaut B., Doyle K.W., Reynolds A.S., et al. Deep structural brain lesions associated with consciousness impairment early after hemorrhagic stroke // Sci Rep. 2019. Vol. 9, N 1. P. 4174. doi: 10.1038/s41598-019-41042-2

[57] Rohaut B, Doyle KW, Reynolds AS, et al. Deep structural brain lesions associated with consciousness impairment early after hemorrhagic stroke. Sci Rep. 2019;9(1):4174. doi: 10.1038/s41598-019-41042-2

[58] Alnagger N, Cardone P, Martial C, et al. The current and future contribution of neuroimaging to the understanding of disorders of consciousness. Presse Med. 2023;52(2):104163. doi: 10.1016/j.lpm.2022.104163

[59] Alnagger N., Cardone P., Martial C., et al. The current and future contribution of neuroimaging to the understanding of disorders of consciousness // Presse Med. 2023. Vol. 52, N 2. P. 104163. doi: 10.1016/j.lpm.2022.104163

[60] Alnagger N, Cardone P, Martial C, et al. The current and future contribution of neuroimaging to the understanding of disorders of consciousness. Presse Med. 2023;52(2):104163. doi: 10.1016/j.lpm.2022.104163

[61] Bakulin IS, Kremneva EI, Kuznetsov AV, et al. Chronic disorders of consciousness. Piradov MA, editor. Moscow: Hot line — Telecom; 2020.

[62] Бакулин И.С., Кремнева Е.И., Кузнецов А.В., и др. Хронические нарушения сознания / под ред. М.А. Пирадова. Москва : Горячая линия-Телеком, 2020.

[63] Bakulin IS, Kremneva EI, Kuznetsov AV, et al. Chronic disorders of consciousness. Piradov MA, editor. Moscow: Hot line — Telecom; 2020.

RIGHTS & PERMISSIONS

Eco-Vector