Abstract
To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months. Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together. Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.
Highlights
To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke
Of the 243 excluded subjects, 104 were excluded for having a GCS score 8 or higher, 58 due to a previous history of any neurological or psychiatric disease, 41 because they were not able to be transferred to the MRI scanner due to their medical condition, 13 because MRI was not performed before death, 10 due to radiologically confirmed brain death during the first 48 h after being admitted to the ICU, eight due to the family’s decision not to participate, and nine due to other reasons (Fig. 1)
Our findings suggest that analysis of functional connectivity of the AAN at specific features of the DTI may serve as a biomarker to predict the state of consciousness after ICU stay depending on the etiology of the injury: the axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) of the gray matter (GM) and white matter (WM) may be predictive in the setting of CPA; the fractional anisotropy (FA) of the GM in TBI; and the AD, MD, and RD of the whole brain, GM and WM in CPA
Summary
To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. Varying impairment in these areas may induce any DOC regardless of the etiology of the injury In this regard, the aim of the present study was to analyze a combination of structural and functional information of the AAN obtained from both DTI and BOLD acquisitions to determine whether early acquisition of DTI and BOLD techniques for analysis of structural and functional connectivity of the AAN can predict neurological outcomes in terms of consciousness in patients with DOCs after TBI, cardiopulmonary arrest (CPA), or stroke
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