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Front. Neurol. | doi: 10.3389/fneur.2018.00110

Could arterial spin labelling distinguish patients in minimally conscious state from patients in vegetative state?

 Bing Wu1,  YI YANG2, Shuai Zhou3, Wei Wang1, Zizhen Wang1, Gang Hu1,  Jianghong He2 and Xinhuai Wu1, 3*
  • 1Department of Radiology, PLA General Hospital, China
  • 2Department of Neurosurgery, PLA General Hospital, China
  • 3Inner Mongolia Medical University, China

PURPOSE:
Diagnostic error is common among patients with vegetative state (VS) and minimally conscious state (MCS). The purpose of this article is to use three-dimensional pseudo-continuous arterial spin labelling (pcASL) to compare cerebral blood flow (CBF) patterns in patients in MCS with those in VS.
METHODS:
Patients meeting MCS and VS criteria were identified. Two post labeling delay time (PLD) pcASL on 3.0-Tesla MRI scanner system were performed with patients in the resting awake state. After registration to T1WI structure imaging, multiple brain regions of interest of ASL CBF map were automatically separated. The average CBF value of every brain region was calculated and compared between the MCS and VS groups with t tests.
RESULTS:
Fifteen patients with VS were identified, with ages ranging from 33 to 71 years. Eight patients who met the MCS criteria ranged in age from 23 to 61 years. Compared with VS, the regional CBF for MCS had a pattern of significantly increased CBF in the regions including the putamen, anterior cingulate gyrus, and medial frontal cortex. A left-lateralised pattern was observed to differentiate MCS from VS. CBF with PLD 2.5 s could find more regions of pattern differentiating MCS from VS than with PLD 1.5 s, except for the pallidum.
CONCLUSION:
MCS might be differentiated from VS by different ranges of regional CBF as measured by ASL. Multi-PLD ASL may serve as an adjunct method to separate MCS from VS and assess functional reserve in patients recovering from severe brain injuries.

Keywords: disorders of consciousness (DOC), minimally conscious state (MCS), vegetative state (VS), arterial spin labeling (ASL), cerebral blood flow (CBF)

Received: 07 Nov 2017; Accepted: 14 Feb 2018.

Edited by:

Marco Sarà, San Raffaele Cassino, Italy

Reviewed by:

Sergio Bagnato, Fondazione Istituto San Raffaele G. Giglio, Italy
Anna Estraneo, Istituti Clinici Scientifici Maugeri Spa SB, Italy  

Copyright: © 2018 Wu, YANG, Zhou, Wang, Wang, Hu, He and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Xinhuai Wu, PLA General Hospital, Department of Radiology, No.5 Nanmencang, Dongcheng District, Beijing, 100700, China, wuxinhuai_beijing@163.com