Disentangling Disorders of Consciousnes: Insights from DTI and MVPA

CNS 2014 Poster: Zheng, Z., Reggente, N. et al. CNS 2014

Summary:

For this poster we used Diffusion Tensor Imaging (DTI) techniques to compute thalamo-cortical probabilistic tractography maps. That is, for every voxel in the Thalamus, we determined every other voxel in the brain’s probabilist structural connectivity with that voxel. We did this for a total of 23 patients diagnosed with disorders of consciousness that fell into one of three possible clinical stratification (Vegetative State(VS), Minimally Conscious State+(MCS+), Minimally Conscious State-(MCS-)). We utilized a support vector machine to observe the patterns local anatomical connectivity of regions of cortex with the thalamus unique to subjects within each of the three groupings. We then used this classifier to “diagnose” unseen subjects in an extensive cross-validation. At times, particularly when using the patterns of activity local to the left prefrontal cortex, we were able to achieve 100% accuracy when distinguishing between VS and MCS+. We used a searchlight-mapping technique to determine which regions in the brain were most informative to classification. We are hoping that this technology could be found useful as a diagnostic aid that relies on the underlying pathology of patients with disorders of consciousness as opposed to the purely behavioral diagnoses currently utilized.

CNS 2014 Abstract:

Disentangling Disorders of Consciousness: Insights from DTI and MVPA

Zhong A. Zheng1, Nicco Reggente1, Evan S. Lutkenhoff1, Adrian Owen2, Martin M. Monti1; 1University of California, Los Angeles, 2University of Western Ontario

The stratification of individuals surviving severe brain injury in Minimally Conscious State (MCS) and Vegetative State (VS) patients is, currently, entirely based on behavioral criteria. This approach is problematic for at least two reasons: (i) behavioral assessments are known to be susceptible to sizeable misdiagnosis (~40%); (ii) this stratification of patients is entirely blind to the underlying pathology. To address both issues, we employed diffusion probabilistic tractography to assess projections from thalamic nuclei in 8 MCS plus (+) patients, who exhibit high-level behavioral responses, 8 MCS minus (-) patients, who only show low-level responses, and 8 VS patients. Evaluation of thalamo-cortical connectivity revealed more connections from the lateral-group nuclei to prefrontal, motor, and sensory regions in MCS+, as compared to VS. Additionally, tractography maps from thalamic nuclei were used as patterns in a logistic regression classification scheme. Using the ventral lateral nucleus’ whole-brain tractography maps as patterns, a leave-two-patients-out cross-validation correctly classified 6/8 VS patients and 7/8 MCS+ patients. This classification relied mostly on increased thalamo-frontal connections in MCS+ patients, as compared to VS. These results suggest that DTI combined with machine learning classification may facilitate the diagnostic distinction between VS and subcategories of MCS by uncovering the neural markers and pathological changes underlying disorders of consciousness.

This work was a collaboration with Zhong (Amy) Sheng Zheng.

 

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