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. 2023 Jun 10;13(12):2026.
doi: 10.3390/diagnostics13122026.

Functional PET Neuroimaging in Consciousness Evaluation: Study Protocol

Tom Paunet  1 , Denis Mariano-Goulart  1 , Jeremy Deverdun  2 , Emmanuelle Le Bars  2 , Marjolaine Fourcade  1 , Florentin Kucharczak  1
Affiliations

Functional PET Neuroimaging in Consciousness Evaluation: Study Protocol

Tom Paunet et al. Diagnostics (Basel). .

Abstract

Ensuring a robust and reliable evaluation of coma deepness and prognostication of neurological outcome is challenging. We propose to develop PET neuroimaging as a new diagnostic and prognosis tool for comatose patients using a recently published methodology to perform functional PET (fPET). This exam permits the quantification of task-specific changes in neuronal metabolism in a single session. The aim of this protocol is to determine whether task-specific changes in glucose metabolism during the acute phase of coma are able to predict recovery at 18 months. Participation will be proposed for all patients coming for a standard PET-CT in our center in order to evaluate global cerebral metabolism during the comatose state. Legally appointed representative consent will be obtained to slightly modify the exam protocol: (1) 18F-fluorodeoxyglucose (18F-FDG) bolus plus continuous infusion instead of a simple bolus and (2) more time under camera to perform dynamic acquisition. Participants will undergo a 55-min fPET session with a 20% bolus + 80% infusion protocol. Two occurrences of three block (5-min rest, 10-min auditory stimulation and 10-min emotional auditory stimulation) will be performed after reaching equilibrium of FDG arterial concentration. We will compare the regional brain metabolism at rest and during the sessions of auditory and emotional auditory stimulation to search for a determinant of coma recovery (18 months of follow-up after the exam). Emotional auditory stimulation should induce an activation of: the auditory cortex, the consciousness areas and the neural circuitry for emotion (function to coma deepness). An activation analysis will be carried out to highlight regional brain activation using dedicated custom-made software based on Python statistical and image processing toolboxes. The association between activation levels and the Coma Recovery Scale-Revisited (CRS-R) will be assessed using multivariate analysis. If successful, the results from this study will help improve coma prognosis evaluation based on the pattern of neuronal metabolism at the onset of the pathology. The study protocol, rationale and methods are described in this paper.

Keywords: 18F-FDG; PET; coma; constant infusion; disorder of consciousness; dynamic PET; fPET; functional PET; glucose metabolism; stimuli.

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Conflict of interest statement

The authors declare no conflict of interest in relation to this protocol.

Figures

Figure 1
Figure 1
Infusion line scheme: (a) subject arm, (b) saline solution, (c) automated injector, (d) modified syringe pump, (e) y-connector with non-return valve to saline solution, (f) motorized 3-way stopcock, (g) syringe pump line.
Figure 2
Figure 2
Stimulations during fPET. rest: no stimulation, aud: auditive stimulation, emo: emotional auditory stimulation and auditive stimulation.
Figure 3
Figure 3
Two-tissue compartmental model. Dotted line shows the reverse rate constant (neglected) and solid lines show transport of 18FDG between different compartments.
See this image and copyright information in PMC

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