• Cristina Rosazza, Adrian Andronache, Davide Sattin, Maria Grazia Bruzzone, Giorgio Marotta, Anna Nigri, Stefania Ferraro, Davide Rossi Sebastiano, Luca Porcu, Anna Bersano, Riccardo Benti, Matilde Leonardi, Ludovico D'Incerti, Ludovico Minati, and Coma Research Center, Besta Institute.
• Neuroradiology Unit, Carlo Besta Institute of Hospitalization and Scientific Care Foundation Neurological Institute, Milan, Italy.
• Ann. Neurol. 2016 May 1; 79 (5): 841-853.

ObjectiveUnderstanding residual brain function in disorders of consciousness poses extraordinary challenges, and imaging examinations are needed to complement clinical assessment. The default-mode network (DMN) is known to be dysfunctional, although correlation with level of consciousness remains controversial. We investigated DMN activity with resting-state functional magnetic resonance imaging (rs-fMRI), alongside its structural and metabolic integrity, aiming to elucidate the corresponding associations with clinical assessment.MethodsWe enrolled 119 consecutive patients: 72 in a vegetative state/unresponsive wakefulness state (VS/UWS), 36 in a minimally conscious state (MCS), and 11 with severe disability. All underwent structural MRI and rs-fMRI, and a subset also underwent 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET). Data were analyzed with manual and automatic approaches, in relation to diagnosis and clinical score.ResultsExcluding the quartile with largest head movement, DMN activity was decreased in VS/UWS compared to MCS, and correlated with clinical score. Independent-component and seed-based analyses provided similar results, although the latter and their combination were most informative. Structural MRI and FDG-PET were less sensitive to head movement and had better diagnostic accuracy than rs-fMRI only when all cases were included. rs-fMRI indicated relatively preserved DMN activity in a small subset of VS/UWS patients, 2 of whom evolved to MCS. The integrity of the left hemisphere appears to be predictive of a better clinical status.Interpretationrs-fMRI of the DMN is sensitive to clinical severity. The effect is consistent across data analysis approaches, but heavily dependent on head movement. rs-fMRI could be informative in detecting residual DMN activity for those patients who remain relatively still during scanning and whose diagnosis is uncertain. Ann Neurol 2016;79:841-853.© 2016 American Neurological Association.

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