Recommendations from the Working Group on Neuroimaging

BackgroundOver the past 5 decades, advances in neuroimaging have yielded insights into the pathophysiologic mechanisms that cause disorders of consciousness (DoC) in patients with severe brain injuries. Structural, functional, metabolic, and perfusion imaging studies have revealed specific neuroanatomic regions, such as the brainstem tegmentum, thalamus, posterior cingulate cortex, medial prefrontal cortex, and occipital cortex, where lesions correlate with the current or future state of consciousness. Advanced imaging modalities, such as diffusion tensor imaging, resting-state functional magnetic resonance imaging (fMRI), and task-based fMRI, have been used to improve the accuracy of diagnosis and long-term prognosis, culminating in the endorsement of fMRI for the clinical evaluation of patients with DoC in the 2018 US (task-based fMRI) and 2020 European (task-based and resting-state fMRI) guidelines. As diverse neuroimaging techniques are increasingly used for patients with DoC in research and clinical settings, the need for a standardized approach to reporting results is clear. The success of future multicenter collaborations and international trials fundamentally depends on the implementation of a shared nomenclature and infrastructure.MethodsTo address this need, the Neurocritical Care Society's Curing Coma Campaign convened an international panel of DoC neuroimaging experts to propose common data elements (CDEs) for data collection and reporting in this field.ResultsWe report the recommendations of this CDE development panel and disseminate CDEs to be used in neuroimaging studies of patients with DoC.ConclusionsThese CDEs will support progress in the field of DoC neuroimaging and facilitate international collaboration.

Automated summary

Advances in neuroimaging have provided insights into the mechanisms causing disorders of consciousness in patients with severe brain injuries. Neuroimaging techniques have improved diagnosis and prognosis, leading to endorsement of fMRI for clinical evaluation. However, standardized reporting is needed for research and collaboration.