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Abstract：
OBJECTIVE: 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 18F-labeled-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in distinguishing between UWS and MCS.
METHODS: 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. 18F-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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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. 18F-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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：与无反应的清醒综合征（UWS）患者相比，处于最低意识状态（MCS）的患者可能受益于旨在改善生活质量的唤醒干预措施，并且恢复更高水平的意识的可能性更高。然而,MCS和UWS的区分在临床实践中提出了挑战。本研究旨在探索从18F标记的氟脱氧葡萄糖正电子发射断层扫描（18F-FDG-PET）中获得的葡萄糖代谢模式（GMP），以区分UWS和MCS。
方法：本前瞻性研究纳入57例意识障碍患者（21例UWS和36例MCS），这些患者接受了重复标准化昏迷恢复量表修订（CRS-R）评估。在所有患者和健康对照(HC)中进行18F-FDG-PET。使用基于体素的缩放子谱模型/主成分分析(SSM/PCA)来生成GMP。获得全脑GMP的表达评分，并将其诊断准确性与标准化摄取值比率（SUVR）进行比较。通过一年后的临床结果验证了诊断效率。
结果：UWS-MCSGMP在额叶-顶叶皮质表现出代谢紊乱，伴随着单侧扁形核的代谢亢进，壳核,和前扣带回。与MCS患者相比，UWS中的UWS-MCS-GMP表达评分明显更高（0.90±0.85vs.0±0.93，p<0.001)。UWS-MCS-GMP表达得分达到0.77的曲线下面积（AUC），以区分MCS和UWS，超过基于额顶皮质的SUVR(AUC=0.623)。UWS-MCS-GMP表达评分与CRS-R评分显着相关（r=-0.45，p=0.004），并准确预测了73.7％患者的一年结局。
结论：UWS和MCS表现出特定的葡萄糖代谢模式，UWS-MCS-GMP表达得分显着区分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。
方法：本前瞻性研究纳入57例意识障碍患者（21例UWS和36例MCS），这些患者接受了重复标准化昏迷恢复量表修订（CRS-R）评估。在所有患者和健康对照(HC)中进行18F-FDG-PET。使用基于体素的缩放子谱模型/主成分分析(SSM/PCA)来生成GMP。获得全脑GMP的表达评分，并将其诊断准确性与标准化摄取值比率（SUVR）进行比较。通过一年后的临床结果验证了诊断效率。
结果：UWS-MCSGMP在额叶-顶叶皮质表现出代谢紊乱，伴随着单侧扁形核的代谢亢进，壳核,和前扣带回。与MCS患者相比，UWS中的UWS-MCS-GMP表达评分明显更高（0.90±0.85vs.0±0.93，p<0.001)。UWS-MCS-GMP表达得分达到0.77的曲线下面积（AUC），以区分MCS和UWS，超过基于额顶皮质的SUVR(AUC=0.623)。UWS-MCS-GMP表达评分与CRS-R评分显着相关（r=-0.45，p=0.004），并准确预测了73.7％患者的一年结局。
结论：UWS和MCS表现出特定的葡萄糖代谢模式，UWS-MCS-GMP表达得分显着区分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。
