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Multimodal FDG-PET and EEG assessment improves diagnosis and prognostication of disorders of consciousness

Abstract : Introduction: Functional brain-imaging techniques have revealed that clinical examination of disorders of consciousness (DoC) can underestimate the conscious level of patients. FDG-PET metabolic index of the best preserved hemisphere (MIBH) has been reported as a promising measure of consciousness but has never been externally validated and compared with other brain-imaging diagnostic procedures such as quantitative EEG. Methods: FDG-PET, quantitative EEG and cognitive evoked potential using an auditory oddball paradigm were performed in minimally conscious state (MCS) and vegetative state (VS) patient. We compared out-sample diagnostic and prognostic performances of PET-MIBH and EEG-based classification of conscious state to the current behavioral gold-standard, the Coma Recovery Scale - revised (CRS-R). Results: Between January 2016 and October 2019, 52 patients were included: 21 VS and 31 MCS. PET-MIBH had an AUC of 0.821 [0.694-0.930], sensitivity of 79% [62-91] and specificity of 78% [56-93], not significantly different from EEG (p = 0.628). Their combination accurately identified almost all MCS patients with a sensitivity of 94% [79-99%] and specificity of 67% [43-85]. Multimodal assessment also identified VS patients with neural correlate of consciousness (4/7 (57%) vs. 1/14 (7%), p = 0.025) and patients with 6-month recovery of command-following (9/24 (38%) vs. 0/16 (0%), p = 0.006), outperforming each technique taken in isolation. Conclusion: FDG-PET MIBH is an accurate and robust procedure across sites to diagnose MCS. Its combination with EEG-based classification of conscious state not only optimizes diagnostic performances but also allows to detect covert cognition and to predict 6-month command-following recovery demonstrating the added value of multimodal assessment of DoC.
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https://hal.sorbonne-universite.fr/hal-03157892
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Submitted on : Wednesday, March 3, 2021 - 3:01:06 PM
Last modification on : Friday, March 5, 2021 - 3:28:39 AM

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Bertrand Hermann, Johan Stender, Marie-Odile Habert, Aurélie Kas, Mélanie Denis-Valente, et al.. Multimodal FDG-PET and EEG assessment improves diagnosis and prognostication of disorders of consciousness. Neuroimage-Clinical, Elsevier, 2021, 30, pp.102601. ⟨10.1016/j.nicl.2021.102601⟩. ⟨hal-03157892⟩

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