EVENT

Paper Published on Frontiers in Neurology(7TMRI)

[发布人]:cjg[发布日期]:2018-01-17[访问次数]:1112

   Dr. Benyan Luo’s Team Reported Early Structural Changes Over a Vegetative Patient through 7T MR Imaging


Spontaneous Recovery from Unresponsive Wakefulness Syndrome to a Minimally Conscious State: Early Structural Changes Revealed by 7-T Magnetic Resonance Imaging


Xufei Tan, Jian Gao, Zhen Zhou, Ruili Wei, Ting Gong, Yuqin Wu, Kehong Liu, Fangping He, Junyang Wang, Jingqi Li, Xiaotong Zhang, Gang Pan* and Benyan Luo*


Background: Determining the early changes of brain structure that occur from vegetative state/unresponsive wakefulness syndrome (VS/UWS) to a minimally conscious state (MCS) is important for developing our understanding of the processes underlying disorders of consciousness (DOC), particularly during spontaneous recovery from severe brain damage.

Objective: This study used a multi-modal neuroimaging approach to investigate early structural changes during spontaneous recovery from VS/UWS to MCS.

Methods: The Coma Recovery Scale-Revised (CRS-R) score, 24-h electroencephalography (EEG), and ultra-high field 7-T magnetic resonance imaging were used to investigate a male patient with severe brain injury when he was in VS/UWS compared to MCS. Using white matter connectometry analysis, fibers in MCS were compared with the same fibers in VS/UWS. Whole-brain analysis was used to compare all fibers showing a 10% increase in density with each other as a population.

Results: Based on connectometry analysis, the number of fibers with increased density, and the magnitude of increase in MCS compared to VS/UWS, was greatest in the area of the temporoparietal junction (TPJ), and was mostly located in the right hemisphere. These results are in accordance with the active areas observed on 24-h EEG recordings. Moreover, analysis of different fibers across the brain, showing at least a 10% increase in density, revealed that altered white matter connections with higher discriminative weights were located within or across visual-related areas, including the cuneus_R, calcarine_R, occipital_sup_R, and occipital_mid_R. Furthermore, the temporal_mid_R, which is related to the auditory cortex, showed the highest increase in connectivity to other areas. This was consistent with improvements in the visual and auditory components of the CRS-R, which were greater than other improvements.

Conclusion: These results provide evidence to support the important roles for the TPJ and the visual and auditory sensory systems in the early recovery of a patient with severe brain injury. Our findings may facilitate a much deeper understanding of the mechanisms underlying conscious-related processes and enlighten treatment strategies for patients with DOC.


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Figure 1. Magnetic resonance imaging (MRI) of the in vivo delineation of the patient’s entire brain at 7 T. 3D-T1-weighted sections of an MRI image of the entire brain obtained at (A) 1.5 months and (B) 5 months after initial injury.


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Figure 2. Tracts with significantly reduced density in the patient during minimally conscious state compared with vegetative state/unresponsive wakefulness syndrome. Specifically, the white matter regions exhibited a reduction mostly in the left hemisphere, and sub-regions of the corpus callosum. Red: leftright, green: anteriorposterior, blue: superiorinferior.


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Figure 3. Tracts with significantly increased density in the patient during minimally conscious state compared with vegetative state/unresponsive wakefulness syndrome. The white matter regions exhibited an increase mostly in the right hemisphere, particularly the tracts of the right superior longitudinal fasciculus and the right arcuate fasciculus connecting the parietal, occipital, and temporal cortices; these showed a greater increase, of more than 30%, in the area of the temporoparietal junction. Red: leftright, green: anteriorposterior, blue: superiorinferior.


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Figure 4. Regional weights and the distribution of 90 white matter connectivity sorted by the automated anatomical labeling-90. Regional weights and the degrees of connection are shown in the circular graph. Different numbers represent the exact fiber numbers or the proportions (as a percentage) of the fibers within one region. Ribbon size encodes the cell value associated with a column segment pair and ribbon ends are colored by column segment.


Online PaperSpontaneous Recovery from Unresponsive Wakefulness Syndrome to a Minimally Conscious State: Early Structural Changes Revealed by 7-T Magnetic Resonance ImagingPDF.pdf


https://www.frontiersin.org/articles/10.3389/fneur.2017.00741/full

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