Multimodal multicentre investigation of diagnostic and prognostic markers in disorders of consciousness

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not specified in abstract

• Primary Outcome: Diagnostic accuracy and prognostic prediction in disorders of consciousness using multimodal assessment

• Nnt Or Sensitivity: Model performance improves with increasing number of modalities; higher inter-modality disagreement for minimally conscious state patients

• Confidence Interval: Not provided

Clinical Application

Requires access to multiple advanced neuroimaging modalities and machine learning expertise, limiting implementation to specialised centres Relevant to major Australian trauma centres and neurological rehabilitation units. May require PBS consideration for advanced imaging protocols. Aligns with ANZICS guidelines for neurological prognostication Severely brain-injured patients with disorders of consciousness in intensive care and rehabilitation settings

Abstract

Severely brain-injured patients may enter a spectrum of conditions collectively known as disorders of consciousness. This spectrum includes clinical conditions such as unresponsive wakefulness syndrome or minimally conscious state, where the behavioural assessment of consciousness can often be deceptive. To bridge this dissociation, neuroimaging techniques are employed to identify the residual brain functions. Each neuroimaging modality imperfectly captures distinct aspects of brain preservation-functional, anatomical, or both. In this study, we adopt a comprehensive approach by integrating the neurophysiology and neuroimaging modalities available from the standard and advanced clinical assessments through interpretable machine learning. The electrophysiological modalities included high-density EEG (resting state and task), whereas neuroimaging modalities included anatomical and resting-state functional MRI, diffusion MRI and 18F-fluorodeoxyglucose PET. Our investigation reveals that specific modalities, such as functional assessments, provide comprehensive insights into the currently evaluated state of consciousness, the diagnosis of the patients. Conversely, structural modalities offer valuable information about the patient's evolution within the consciousness spectrum. We validate the proposed analysis with data coming from other centres with different acquisition parameters. Importantly, we demonstrate that model performance improves with an increase in the number of modalities. We observe a higher inter-modality disagreement for minimally conscious state patients and those patients who improve. Lastly, we observe a difference in feature importances between diagnosis and prognosis, with an interaction between modality and anatomical structures: some subcortical markers tend to contribute more to prognosis, while other cortical markers are more informative for diagnosis. This integrative multimodal and machine learning methodology presents a promising avenue for a more nuanced understanding of disorders of consciousness, contributing to enhanced diagnostic precision, prognostic capabilities and the personalization of rehabilitative strategies in clinical practice.

References

1. 1.Manasova, D., Belloli, L. M. L., Rosenfelder, M. J., Willacker, L., Fló Rama, E., Valota, C., Hermann, B., Kaufmann, B. C., Pirastru, A., Derchi, C. C., Raiser, T., Valente, M., Sangare, A., Türker, B., Pyatigorskaya, N., Béranger, B., Colombo, M., Munoz-Musat, E., Escrichs, A., Atzori, T., Baglio, F., Lapa, C., Berlis, A., Krüger, K., Luther, T., Perlbarg, V., Deco, G., Sanz-Perl, Y., Tagliazucchi, E., Puybasset, L., Rohaut, B., Naccache, L., Comanducci, A., Arzi, A., Rosanova, M., Bender, A., & Sitt, J. D. (2026). Multimodal multicentre investigation of diagnostic and prognostic markers in disorders of consciousness. *Brain*, *awaf412*. https://doi.org/10.1093/brain/awaf412