title: Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients.
abstract: The differentiation of the vegetative or unresponsive wakefulness syndrome (VS/UWS) from the minimally conscious state (MCS) is an important clinical issue. The cerebral metabolic rate of glucose (CMRglc) declines when consciousness is lost, and may reveal the residual cognitive function of these patients. However, no quantitative comparisons of cerebral glucose metabolism in VS/UWS and MCS have yet been reported. We calculated the regional and whole-brain CMRglc of 41 patients in the states of VS/UWS (n=14), MCS (n=21) or emergence from MCS (EMCS, n=6), and healthy volunteers (n=29). Global cortical CMRglc in VS/UWS and MCS averaged 42% and 55% of normal, respectively. Differences between VS/UWS and MCS were most pronounced in the frontoparietal cortex, at 42% and 60% of normal. In brainstem and thalamus, metabolism declined equally in the two conditions. In EMCS, metabolic rates were indistinguishable from those of MCS. Ordinal logistic regression predicted that patients are likely to emerge into MCS at CMRglc above 45% of normal. Receiver-operating characteristics showed that patients in MCS and VS/UWS can be differentiated with 82% accuracy, based on cortical metabolism. Together these results reveal a significant correlation between whole-brain energy metabolism and level of consciousness, suggesting that quantitative values of CMRglc reveal consciousness in severely brain-injured patients.
authors.affiliation: 1] Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark [2] Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Stender
authors.affiliation: Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ron
authors.initials: R
authors.lastname: Kupers
authors.affiliation: 1] Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark [2] Centre for Advanced Imaging, University of Queensland, Brisbane, Australia.
authors.forename: Anders
authors.initials: A
authors.lastname: Rodell
authors.affiliation: Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium.
authors.forename: Aurore
authors.initials: A
authors.lastname: Thibaut
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Camille
authors.initials: C
authors.lastname: Chatelle
authors.affiliation: Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium.
authors.forename: Marie-Aurélie
authors.initials: MA
authors.lastname: Bruno
authors.affiliation: 1] Centre for Advanced Imaging, University of Queensland, Brisbane, Australia [2] Department of Biomedicine-Pharmacology, Aarhus University, Aarhus, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Gejl
authors.affiliation: Department of Nuclear Medicine, University Hospital of Liège, Liège, Belgium.
authors.forename: Claire
authors.initials: C
authors.lastname: Bernard
authors.affiliation: Department of Nuclear Medicine, University Hospital of Liège, Liège, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Hustinx
authors.affiliation: Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.affiliation: 1] Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark [2] Department of Neurology, McGill University, Montréal, Québec, Canada [3] Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Gjedde
mesh_terms: D000328:Adult; D001345:Autoradiography; D001786:Blood Glucose / Q000032:analysis; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D001931:Brain Mapping; D016022:Case-Control Studies; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D049268:Positron-Emission Tomography; D014851:Wakefulness / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18; D005947:Glucose