{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:00:26Z","timestamp":1780981226210,"version":"3.54.1"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical diagnosis of prolonged disorders of consciousness (pDoC) relies primarily on behavioral scales, which lack sensitivity to covert cerebral cognitive activity and carry a risk of misdiagnosis. Few studies integrate structural and functional brain abnormalities to explore pDoC. The objective of this study was to employ resting-state functional magnetic resonance imaging (rs-fMRI) with diffusion tensor imaging (DTI) to delineate multimodal neuroimaging abnormalities in pDoC, clarify its neural mechanisms, and identify potential neuroimaging biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighteen patients with pDoC and 20 healthy controls (HCs) underwent rs-fMRI and DTI acquisition. Key metrics included fractional anisotropy (FA), amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and functional connectivity (FC). Correlations between these metrics and Coma Recovery Scale-Revised (CRS-R) scores were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with HCs, pDoC patients exhibited reduced FA in the left anterior corona radiata (ACR-L) (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), altered ALFF\/fALFF\/ReHo in prefrontal, cerebellar, and limbic regions, and disrupted FC within higher-order cortical networks. CRS-R scores positively correlated with ACR-L FA and prefrontal ReHo, and negatively correlated with cerebellar and limbic hyperactivity (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with pDoC demonstrate three simultaneous tiers of pathological co-alterations: extensive white matter structural disruption with peak significance in ACR-L; disintegration of higher-order cortical networks; patterns of hyperactivity and hyperconnectivity in the cerebellum, limbic system, and angular gyrus. Our findings provide a framework for understanding the pathophysiological mechanisms underlying consciousness impairment in pDoC. The neuroimaging biomarkers found in this study facilitate objective pDoC assessment and prognostic evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1797576","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:28:08Z","timestamp":1780979288000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal MRI reveals three-tiered pathological co-alterations in prolonged disorders of consciousness: structural disconnection, network disintegration, and regional hyperconnectivity"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiyong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianbin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1016\/S1474-4422(19)30031-6","article-title":"Therapeutic interventions in patients with prolonged disorders of consciousness","volume":"18","author":"Thibaut","year":"2019","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1212\/WNL.0000000000005926","article-title":"Practice guideline update recommendations summary: disorders of consciousness: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of neurology; the American congress of rehabilitation medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research","volume":"91","author":"Giacino","year":"2018","journal-title":"Neurology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1111\/ene.14151","article-title":"European academy of neurology guideline on the diagnosis of coma and other disorders of consciousness","volume":"27","author":"Kondziella","year":"2020","journal-title":"Eur J Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1016\/j.neuron.2024.04.027","article-title":"Toward an interventional science of recovery after coma","volume":"112","author":"Schiff","year":"2024","journal-title":"Neuron"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1056\/NEJMoa2400645","article-title":"Cognitive motor dissociation in disorders of consciousness","volume":"391","author":"Bodien","year":"2024","journal-title":"N Engl J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1002\/mrm.1910340409","article-title":"Functional connectivity in the motor cortex of resting human brain using echo-planar MRI","volume":"34","author":"Biswal","year":"1995","journal-title":"Magn Reson Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"102601","DOI":"10.1016\/j.nicl.2021.102601","article-title":"Multimodal FDG-PET and EEG assessment improves diagnosis and prognostication of disorders of consciousness","volume":"30","author":"Hermann","year":"2021","journal-title":"NeuroImage Clin"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1097\/WCO.0000000000000873","article-title":"MRI in disorders of consciousness","volume":"33","author":"Snider","year":"2020","journal-title":"Curr Opin Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1038\/s41582-020-00428-x","article-title":"Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies","volume":"17","author":"Edlow","year":"2021","journal-title":"Nat Rev Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.neuroscience.2021.06.031","article-title":"Disrupted strength and stability of regional brain activity in disorder of consciousness patients: a resting-state functional magnetic resonance imaging study","volume":"469","author":"Yu","year":"2021","journal-title":"Neuroscience"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s00234-022-02911-2","article-title":"Regional homogeneity alterations in patients with impaired consciousness. 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