Conventional structural magnetic resonance imaging in differentiating chronic disorders of consciousness

Anastasia N. Sergeeva; Сергеева Анастасия Николаевна; Anastasia N. Sergeeva; Sofya N. Morozova; Морозова Софья Николаевна; Sofya N. Morozova; Dmitrii V. Sergeev; Сергеев Дмитрий Владимирович; Dmitrii V. Sergeev; Elena I. Kremneva; Кремнева Елена Игоревна; Elena I. Kremneva; Alexey A. Zimin; Зимин Алексей Алексеевич; Alexey A. Zimin; Lyudmila A. Legostaeva; Легостаева Людмила Александровна; Lyudmila A. Legostaeva; Elizaveta G. Iazeva; Язева Елизавета Григорьевна; Elizaveta G. Iazeva; Marina V. Krotenkova; Кротенкова Марина Викторовна; Marina V. Krotenkova; Yulia V. Ryabinkina; Рябинкина Юлия Валерьевна; Yulia V. Ryabinkina; Natalya A. Suponeva; Супонева Наталья Александровна; Natalya A. Suponeva; Michael A. Piradov; Пирадов Михаил Александрович; Michael A. Piradov

doi:10.17816/DD569418

Conventional structural magnetic resonance imaging in differentiating chronic disorders of consciousness

Autores: Sergeeva A.N.¹, Morozova S.N.¹, Sergeev D.V.¹, Kremneva E.I.¹, Zimin A.A.¹, Legostaeva L.A.¹, Iazeva E.G.², Krotenkova M.V.¹, Ryabinkina Y.V.¹, Suponeva N.A.¹, Piradov M.A.¹
Afiliações:
1. Research Center of Neurology
2. LLC “Three sisters” Rehabilitation center
Edição: Volume 5, Nº 2 (2024)
Páginas: 190-202
Seção: Original Study Articles
URL: https://journal-vniispk.ru/DD/article/view/264832
DOI: https://doi.org/10.17816/DD569418
ID: 264832

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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.

Palavras-chave

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

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Bibliografia

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2. Fig. 1. DOC-MRIDS score: a–d — on the example of a healthy volunteer; e–h — on the example of a patient with CNS. The indicated distances: a–b — cortex thickness; b–c — sulcus width; h–i — thickness of the central part of the corpus callosum; distances d–e and f–g were used to calculate the Evans index. Areas highlighted in blue: a — unchanged thalamus; c — brainstem; e — degeneration of thalamus; g — degeneration of brainstem. Lines: e— red dotted lines indicate the prevalence of leukoaraiosis; h — solid blue line marks hypointense foci in the corpus callosum.

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3. Fig. 2. Negative correlation between the CRS-R and DOC-MRIDS scores (ρ=–0.457, p<0.0001). Red dots – vegetative state group; blue dots – minimally conscious state group.

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4. Fig. 3. ROC curve for distinguishing between vegetative state and minimally conscious state patients (AUC = 0.71; P = 0.005). ROC, receiver operating characteristic

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