Prognostic Value Of Cerebral Activation To Presentation Of The Own Name In Patients With Disorders Of Consciousness

Objective:How to across the clinical abyss to obtain an accurate diagnosis and prognosis for the patients in disorders of consciousness is still a challenge for clinicians. The patients’ability of movement can be subtle and can fluctuate over time, this has created a situation in which the rate of misdiagnosis is unacceptably high. In order to get supplementary diagnosis proof, a study was proposed in a large sample of patients to test the prognostic value of patients’own name using fMRI and took etiology into consideration. Furthermore, to assess the overlap between twice-scan own name task and clinical applying value of this fMRI paradigm.Method:We performed this study in66patients with disorders of consciousness (39VS/UWS,25MCS,2EMCS) which was diagnosed relying on the standard scale CRS-R at two major referral centers. Using fMRI to assess the change of blood oxygen level dependent (BOLD) signal when the patients expose to his/her name called by a familiar voice, moreover,13patients were scanned twice in one day employing own name task. A follow-up program was also carried out in3,6and12month after scanning. Then synthesized the result of fMRI and follow-up program, to obtain the correlation between activation type, activation volume in auditory cortex and recovery of own name task.Results:In16VS/UWS patients who showed activation in higher order associate auditory cortex,12(75.0%) recovered to MCS or EMCS, and in remaining23VS/UWS patients who show no activation or activation limited in primary auditory cortex,17(73.9%) exhibited a bad result. The sensitivity and specificity of this method was66.7%and81.0%respectively in VS/UWS cohort. After dividing39VS/UWS patients into2groups (traumatic and non-traumatic) according to etiology:In23traumatic VS/UWS patients, if patients show atypical activation beyond primary auditory cortex,12(92.3%) out of13have good recovery; And in16non-traumatic VS/UWS patients,11(85.0%) out13patients with no or primary auditory cortex activation have bad outcome. ROC curve analysis found significant correlation between activation volume in bilateral, right side and left side auditory cortex and VS/UWS patients’recovery, when the activation volume was bigger than5355mm3(p<0.01). And in23traumatic VS/UWS patients, ROC curve showed the activation volume of bilateral primary and secondary auditory cortex was significant correlated with the recovery when the activation volume was more than3680mm3(p<0.01). In13patients who were scanned twice at the same day,8out of13(5VS/UWS,3MCS) showed50%or75%overlap between two separately scan,2(1VS/UWS,1MCS) patients’overlap rate was25%,1(MCS) patient’ overlap rate was100%,2out of13(1VS,1MCS) patients showed no overlap. The average overlap rate was52%.Conclusion:Different activation type and activation volume in auditory cortex generated by own name using fMRI has great potential to determine VS/UWS patients’prognosis, especially after regarding to VS/UWS patients etiology (traumatic and non-traumatic). Considering the overlap rate of two separately scan in patients with disorder of consciousness, a patient with severely brain injury was instructed to be scanned repeatedly. All these results inferred that this own name fMRI paradigm was necessary for patients with disorders of consciousness, and it could also promote the clinical use of fMRI in this cohort.