Resting-state based prediction of task-related activation in patients with disorders of consciousness
Bibliographic record
Abstract
ABSTRACT Background Assessment of the level of awareness of people with disorders of consciousness (DOC) is clinically challenging, motivating several studies to combine brain imaging with machine learning to improve this process. While this work has shown promise, it has limited clinical utility, as misdiagnosis of DOC patients is relatively high. As machine learning algorithms rely on accurately labelled data, any error in diagnosis will be learned by the algorithm, resulting in an equally limited diagnostic tool. The goal of the present study is to overcome this problem by stratifying patients, not by diagnosis, but by their capacity to perform volitional tasks during functional magnetic resonance imaging (fMRI) scanning. Methods A total of 71 patients were assessed for inclusion. They were excluded for the final analysis if they had large focal brain damage, excessive head motion during scanning, or suboptimal MRI preprocessing. Patients underwent both resting-state and task-based fMRI scanning. Univariate fMRI analysis was performed to determine if an individual patient had brain activity consistent with having retained volitional capacity (VC). Differences in resting brain network connectivity between patients with VC and patients without volitional capacity (non-VC) were measured. Connectivity data was then entered as input to a deep learning framework. We used a deep graph convolutional neural network (DGCNN) on connectivity data to identify a specific brain network that most significantly differentiates patients. Findings We included 30 patients in our final analysis. Univariate analysis revealed that 13 patients displayed signs of VC, while 17 did not. We found that resting-state connectivity between frontoparietal control and salience network was significantly different between VC and non-VC patients (T(28) = 3.347, p = 0.0023, Bonferroni corrected p = 0.042). Furthermore, we found that using frontoparietal control network connectivity as input to the DGCNN resulted in the best classification performance (test accuracy = 0.85; ROC AUC = 0.92). Interpretation We found that the DGCNN performed best at discriminating between patients with VC when using only the frontoparietal control network as input to the model. The use of this deep learning method is a significant advance since its inherent flexibility permits the inclusion of both whole-brain and network-specific properties as input, allowing us to classify patients as either having or not having VC. This inclusion of multi-scale inputs (e.g. whole-brain and network-level) facilitates model interpretability and increases our understanding of the neurobiology of DOC. The results propose that the integrity of frontoparietal control network, a brain network well known to play a key role in executive functions and cognitive control, is essential for volitional capacity preservation in patients with DOC. The study also lays groundwork for development of a biomarker to aid in the diagnosis of DOC patients. RESEARCH IN CONTEXT Evidence before this study Disorders of consciousness (DOC) are a group of severe brain disorders characterised by damage to the neural systems underlying wakefulness and awareness. DOC are often caused by traumatic brain injury, hypoxia, or neurodegenerative diseases. The motor and cognitive impairments in DOC patients make providing an accurate diagnosis very challenging. Diagnosis is primarily made at the bedside by assessing a patient’s response to motor commands.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".