Advanced neuroimaging techniques to decipher brain connectivity networks in patients with disorder of consciousness: a narrative review

Abstract

Advanced neuroimaging techniques have revolutionized our ability to decode brain networks in patients with disorders of consciousness (DoC), offering unprecedented insights into the structural and functional underpinnings of consciousness impairment. This review systematically examines and summarizes the clinical applications of modern neuroimaging methodologies-specifically functional MRI and diffusion MRI- for DoC patients from three key perspectives: (1) pathogenic mechanism and theory evolution, (2) accurate diagnosis and prognosis assessment, and (3) treatment strategy and efficacy evaluation. By integrating network neuroscience with clinical insights, we highlight the transformative role of neuroimaging in unraveling network-level damage, refining clinical assessments, and guiding therapeutic innovations. We further outline the potential applicational challenges associated with leveraging neuroimaging techniques to advance both scientific research on consciousness networks and clinical practice in DoC management, hoping to better address these complex conditions.

Keywords: Brain network; Clinical application; Connectivity; Disorders of consciousness; Neuroimaging.

Fig. 1

The clinical application of advanced neuroimaging techniques in DoC. Leveraging high-spatial-resolution dMRI and fMRI, the structural and functional connectivity of brain networks in DoC patients are non-invasively and comprehensively deciphered (A), revealing the underlying neural mechanisms of DoC from a network neuroscience perspective. The cerebral cortex, which governs both internal and external awareness, and subcortical structures that maintain physiological arousal are both integral to human consciousness (B, C). Following acquired brain injury, the extensive interplay between cortical awareness networks and subcortical arousal network is disrupted, resulting in dysfunction of the neural circuits that sustain consciousness (D). Furthermore, based on graph theory, network dynamics and whole-brain computational models, abnormalities in brain information communication, temporal dynamics and global homeostasis are revealed in DoC patients (E, F, G). These insights are instrumental in DoC clinical practice, aiding in consciousness assessment and treatment strategies. The network connectivity characteristics can serve as robust neural correlates of consciousness for accurate diagnosis and prognosis prediction (H). In particular, task-evoked brain activity is useful for CMD detection and multimodal integration is essential for DoC management (I, J). Finally, advanced neuroimaging techniques guide the target selection and response evaluation in drug therapy, non-invasive, and invasive neuromodulations, thereby facilitating the neurorehabilitation for DoC patients (K, L, M). DoC, disorders of consciousness; dMRI, diffusion MRI; fMRI, functional MRI; CMD, cognitive motor dissociation; PCC/PCu, posterior cingulate cortex/precuneus; dlPFC, dorsolateral prefrontal cortex; mPFC, medial prefrontal cortex; IPS, intraparietal sulcus; IPL, inferior parietal lobule; ARAS, ascending reticular activating system; Str, striatum; GPi, globus pallidus interna; MCS, minimally conscious state; UWS, unresponsive wakefulness syndrome; VTA, ventral tegmental area; LIFU, low-intensity focused ultrasound; taVNS, transcutaneous auricular vagus nerve stimulation; DBS, deep brain stimulation; SCS, spinal cord stimulation. Created in BioRender. zhu, s. (2025) https://BioRender.com/39eulzs.