Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state
Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state
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DOI：
10.1016/j.neuroimage.2010.08.035
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发表时间：
2011-01-01
期刊：
影响因子：
5.7
通讯作者：
Owen, Adrian M.
中科院分区：
文献类型：
--
作者：
Fernandez-Espejo, Davinia;Bekinschtein, Tristan;Owen, Adrian M.
植物人状态(VS)和最低意识状态(MCS)目前是根据表现出的行为而不是潜在的病理来区分的。虽然以往的组织病理学研究已证实VS和MCS存在不同程度的弥漫性轴索损伤以及丘脑和脑干区的损害，但这些差异尚未在活体内进行评估，因此不能提供可测量的病理标志物来辅助临床诊断。目前，诊断决策过程主观性强，容易出错。事实上，以前的研究表明，这一群体中高达43%的患者可能被误诊。我们使用弥散张量成像(DTI)研究了25名植物和意识最低的患者体内的神经病理，并确定了可能区分这两组患者的措施。绘制皮质下白质、脑干和丘脑的平均弥散系数(MD)图。MCS和VS患者在皮质下白质和丘脑区域有显著差异，但在脑干似乎没有差异。此外，DTI结果预测了昏迷恢复量表的得分(p
The vegetative (VS) and minimally conscious (MCS) states are currently distinguished on the basis of exhibited behaviour rather than underlying pathology. Although previous histopathological studies have documented different degrees of diffuse axonal injury as well as damage to the thalami and brainstem regions in VS and MCS, these differences have not been assessed in vivo, and therefore, do not provide a measurable pathological marker to aid clinical diagnosis. Currently, the diagnostic decision-making process is highly subjective and prone to error. Indeed, previous work has suggested that up to 43% of patients in this group may be misdiagnosed. We used diffusion tensor imaging (DTI) to study the neuropathology of 25 vegetative and minimally conscious patients in vivo and to identify measures that could potentially distinguish the patients in these two groups. Mean diffusivity (MD) maps of the subcortical white matter, brainstem and thalami were generated. The MCS and VS patients differed significantly in subcortical white matter and thalamic regions, but appeared not to differ in the brainstem. Moreover, the DTI results predicted scores on the Coma Recovery Scale (p