{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:05:12Z","timestamp":1789635912651,"version":"4.0.0"},"reference-count":57,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: We investigate the relationship between the loss of consciousness (LOC) and the state of default mode network (DMN) connectivity in diffuse axonal injury (DAI) patients, using diffusion tensor tractography (DTT). Methods: Twenty-one consecutive patients with DAI were recruited in this study. The DMN connectivity [medial prefrontal cortex (mPFC)\u2014posterior cingulate cortex (PCC)\/precuneus and retrosplenial cortex (RSC)\u2014medial temporal lobe (MTL)] was reconstructed using DTT. Fractional anisotropy (FA) value, mean diffusivity (MD) value, and tract volume (TV) of the DMN connectivity at the chronic stage were measured in this study. Results: After adjusting for covariates, none of the DTT parameters reached definitive statistical significance at the p &lt; 0.05 level. However, the LOC duration revealed a marginal trend toward a negative correlation with the TV of the mPFC-PCC\/precuneus neural connectivity (partial r = \u22120.466, p = 0.060) and a marginal trend toward a positive correlation with the MD value of the MTL-RSC neural connectivity (partial r = 0.467, p = 0.059). The FA and MD of the mPFC-PCC\/precuneus, and the FA and TV of the MTL-RSC, showed no significant associations (p &gt; 0.05). Conclusions: This exploratory study identified a marginal trend between the LOC duration and the state of DMN connectivity (mPFC-PCC\/precuneus and MTL-RSC) at the chronic stage in DAI patients. Chronic-stage microstructural changes in the DMN are likely influenced by several factors, including the severity of the initial injury and the time since injury. Therefore, although the LOC duration provides useful clinical information, it should not be considered a direct predictor of chronic DMN deterioration in patients with DAI.<\/jats:p>","DOI":"10.3390\/jcm15187205","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:03:17Z","timestamp":1789632197000},"page":"7205","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Loss of Consciousness and the Default Mode Network at the Chronic Stage of Diffuse Axonal Injury: A Diffusion Tensor Imaging Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6383-5505","authenticated-orcid":false,"given":"Sung Ho","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Min Jye","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4537-6813","authenticated-orcid":false,"given":"Dong Hyun","family":"Byun","sequence":"additional","affiliation":[{"name":"Department of Special Creative Convergence, College of Rehabilitation Sciences, Daegu University, Jillyang-Eup, Gyeongsan-si 38453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1080\/0269905031000149542","article-title":"Acute confusion following traumatic brain injury","volume":"18","author":"Sherer","year":"2004","journal-title":"Brain Inj."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/00001199-200307000-00003","article-title":"Diffuse axonal injury in head trauma","volume":"18","author":"Smith","year":"2003","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/j.1365-2559.1989.tb03040.x","article-title":"Diffuse axonal injury in head injury: Definition, diagnosis and grading","volume":"15","author":"Adams","year":"1989","journal-title":"Histopathology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1002\/ana.410120610","article-title":"Diffuse axonal injury due to nonmissile head injury in humans: An analysis of 45 cases","volume":"12","author":"Adams","year":"1982","journal-title":"Ann. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1007\/s003300050496","article-title":"Imaging findings in diffuse axonal injury after closed head trauma","volume":"8","author":"Parizel","year":"1998","journal-title":"Eur. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1053\/apmr.2001.25137","article-title":"Current concepts: Diffuse axonal injury-associated traumatic brain injury","volume":"82","author":"Meythaler","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.annemergmed.2003.11.010","article-title":"Delayed presentation of diffuse axonal injury: A case report","volume":"44","author":"Corbo","year":"2004","journal-title":"Ann. Emerg. Med."},{"key":"ref_8","unstructured":"Management of Concussion\/mTBI Working Group (2009). VA\/DoD Clinical Practice Guideline for Management of Concussion\/Mild Traumatic Brain Injury. J. Rehabil. Res. Dev., 46, CP1\u2013CP68."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.suc.2012.04.005","article-title":"Spectrum of traumatic brain injury from mild to severe","volume":"92","author":"Decuypere","year":"2012","journal-title":"Surg. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1001\/jamaneurol.2015.3188","article-title":"Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury","volume":"73","author":"Suwatcharangkoon","year":"2016","journal-title":"JAMA Neurol."},{"key":"ref_11","unstructured":"Cooper, P.R. (1993). Cerebral concussion and diffuse brain injuries. Head Injury, Williams & Wilkins. [3rd ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"663","DOI":"10.2214\/ajr.150.3.663","article-title":"MR imaging of head trauma: Review of the distribution and radiopathologic features of traumatic lesions","volume":"150","author":"Gentry","year":"1988","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mars, R.B., Neubert, F.X., Noonan, M.P., Sallet, J., Toni, I., and Rushworth, M.F. (2012). On the relationship between the \u201cdefault mode network\u201d and the \u201csocial brain\u201d. Front. Hum. Neurosci., 6.","DOI":"10.3389\/fnhum.2012.00189"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1002\/hbm.23983","article-title":"The retrosplenial cortex: A memory gateway between the cortical default mode network and the medial temporal lobe","volume":"39","author":"Kaboodvand","year":"2018","journal-title":"Hum. Brain Mapp."},{"key":"ref_15","unstructured":"Swaiman, K.F., Ashwal, S., Ferriero, D.M., and Schor, N.F. (2017). Disorders of consciousness in children. Swaiman\u2019s Pediatric Neurology: Principles and Practice, Elsevier. [6th ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9318","DOI":"10.1073\/pnas.1721259115","article-title":"Default mode network can support the level of detail in experience during active task states","volume":"115","author":"Sormaz","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/ana.23635","article-title":"A role for the default mode network in the bases of disorders of consciousness","volume":"72","author":"Soddu","year":"2012","journal-title":"Ann. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1002\/hbm.23429","article-title":"Structural and functional connectivity of the precuneus and thalamus to the default mode network","volume":"38","author":"Cunningham","year":"2017","journal-title":"Hum. Brain Mapp."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1002\/ana.24479","article-title":"How are different neural networks related to consciousness?","volume":"78","author":"Qin","year":"2015","journal-title":"Ann. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.conb.2012.12.003","article-title":"Consciousness supporting networks","volume":"23","author":"Demertzi","year":"2013","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S0079-6123(05)50015-3","article-title":"Posterior cingulate, precuneal and retrosplenial cortices: Cytology and components of the neural network correlates of consciousness","volume":"150","author":"Vogt","year":"2005","journal-title":"Prog. Brain Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2991","DOI":"10.1016\/j.cub.2017.08.025","article-title":"Single-Neuron Correlates of Conscious Perception in the Human Medial Temporal Lobe","volume":"27","author":"Reber","year":"2017","journal-title":"Curr. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1093\/cercor\/bhn059","article-title":"Resting-state functional connectivity reflects structural connectivity in the default mode network","volume":"19","author":"Greicius","year":"2009","journal-title":"Cereb. Cortex"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Crone, J.S., Ladurner, G., H\u00f6ller, Y., Golaszewski, S., Trinka, E., and Kronbichler, M. (2011). Deactivation of the default mode network as a marker of impaired consciousness: An fMRI study. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026373"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1002\/ana.24634","article-title":"Multimodal study of default-mode network integrity in disorders of consciousness","volume":"79","author":"Rosazza","year":"2016","journal-title":"Ann. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"38866","DOI":"10.1038\/srep38866","article-title":"Distinct Interactions between Fronto-Parietal and Default Mode Networks in Impaired Consciousness","volume":"6","author":"Long","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107294","DOI":"10.1016\/j.clineuro.2022.107294","article-title":"Abnormal default mode network could be a potential prognostic marker in patients with disorders of consciousness","volume":"218","author":"Zhang","year":"2022","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.nicl.2015.11.004","article-title":"Relationship between the anterior forebrain mesocircuit and the default mode network in the structural bases of disorders of consciousness","volume":"10","author":"Lant","year":"2015","journal-title":"Neuroimage Clin."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.neuroimage.2015.01.037","article-title":"Impaired consciousness is linked to changes in effective connectivity of the posterior cingulate cortex within the default mode network","volume":"110","author":"Crone","year":"2015","journal-title":"Neuroimage"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.nicl.2013.12.005","article-title":"Altered network properties of the fronto-parietal network and the thalamus in impaired consciousness","volume":"4","author":"Crone","year":"2013","journal-title":"Neuroimage Clin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/S1474-4422(16)00111-3","article-title":"Neural correlates of consciousness in patients who have emerged from a minimally conscious state: A cross-sectional multimodal imaging study","volume":"15","author":"Bahri","year":"2016","journal-title":"Lancet Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1212\/WNL.0b013e31823fcd61","article-title":"Disruptions of functional connectivity in the default mode network of comatose patients","volume":"78","author":"Norton","year":"2012","journal-title":"Neurology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/s12028-014-9953-3","article-title":"MRI default mode network connectivity is associated with functional outcome after cardiopulmonary arrest","volume":"20","author":"Koenig","year":"2014","journal-title":"Neurocrit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/brain\/awp313","article-title":"Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients","volume":"133","author":"Vanhaudenhuyse","year":"2010","journal-title":"Brain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1002\/hbm.21249","article-title":"Identifying the default-mode component in spatial IC analyses of patients with disorders of consciousness","volume":"33","author":"Soddu","year":"2012","journal-title":"Hum. Brain Mapp."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1212\/WNL.0b013e3182a43b78","article-title":"Limbic hyperconnectivity in the vegetative state","volume":"81","author":"Bastianello","year":"2013","journal-title":"Neurology"},{"key":"ref_37","first-page":"1049","article-title":"Diffuse axonal injury associated with chronic traumatic brain injury: Evidence from T2-weighted gradient-echo imaging at 3 T","volume":"24","author":"Scheid","year":"2003","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S208","DOI":"10.1016\/j.neuroimage.2004.07.051","article-title":"Advances in functional and structural MR image analysis and implementation as FSL","volume":"23","author":"Smith","year":"2004","journal-title":"Neuroimage"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1038\/nn1075","article-title":"Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging","volume":"6","author":"Behrens","year":"2003","journal-title":"Nat. Neurosci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.neuroimage.2006.09.018","article-title":"Probabilistic diffusion tractography with multiple fibre orientations: What can we gain?","volume":"34","author":"Behrens","year":"2007","journal-title":"Neuroimage"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1002\/cne.24212","article-title":"Anatomical segmentation of the human medial prefrontal cortex","volume":"525","author":"Ubero","year":"2017","journal-title":"J. Comp. Neurol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1002\/cne.901690105","article-title":"Retrosplenial cortex in the rhesus monkey: A cytoarchitectonic and Golgi study","volume":"169","author":"Vogt","year":"1976","journal-title":"J. Comp. Neurol."},{"key":"ref_43","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/1531-8249(199902)45:2<265::AID-ANA21>3.0.CO;2-3","article-title":"Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging","volume":"45","author":"Mori","year":"1999","journal-title":"Ann. Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s12031-007-0029-0","article-title":"Diffusion tensor imaging (DTI)-based white matter mapping in brain research: A review","volume":"34","author":"Assaf","year":"2008","journal-title":"J. Mol. Neurosci."},{"key":"ref_46","first-page":"226","article-title":"Cognitive aging, executive function, and fractional anisotropy: A diffusion tensor MR imaging study","volume":"28","author":"Grieve","year":"2007","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s00330-007-0733-8","article-title":"Quantitative diffusion tensor fiber tracking of age-related changes in the limbic system","volume":"18","author":"Stadlbauer","year":"2008","journal-title":"Eur. Radiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1159\/000077817","article-title":"Ultrastructural hippocampal and white matter alterations in mild cognitive impairment: A diffusion tensor imaging study","volume":"18","author":"Fellgiebel","year":"2004","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s43055-019-0082-z","article-title":"Diffusion tensor imaging f white matter integrity in relation to smoking index and exacerbations in severe chronic obstructive pulmonary disease","volume":"50","author":"Helmy","year":"2019","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s00234-014-1419-y","article-title":"Injury of the lower ascending reticular activating system in patients with hypoxic-ischemic brain injury: Diffusion tensor imaging study","volume":"56","author":"Jang","year":"2014","journal-title":"Neuroradiology"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Figley, C.R., Uddin, M.N., Wong, K., Kornelsen, J., Puig, J., and Figley, T.D. (2022). Potential Pitfalls of Using Fractional Anisotropy, Axial Diffusivity, and Radial Diffusivity as Biomarkers of Cerebral White Matter Microstructure. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.799576"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1089\/neu.2015.4212","article-title":"Loss of Consciousness Is Related to White Matter Injury in Mild Traumatic Brain Injury","volume":"33","author":"Wilde","year":"2016","journal-title":"J. Neurotrauma"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1097\/PHM.0000000000001243","article-title":"The Relation Between Loss of Consciousness, Severity of Traumatic Brain Injury, and Injury of Ascending Reticular Activating System in Patients with Traumatic Brain Injury","volume":"98","author":"Jang","year":"2019","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1007\/s11682-015-9432-2","article-title":"Brainstem white matter integrity is related to loss of consciousness and postconcussive symptomatology in veterans with chronic mild to moderate traumatic brain injury","volume":"9","author":"Bangen","year":"2015","journal-title":"Brain Imaging Behav."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"165","DOI":"10.2463\/mrms.8.165","article-title":"MR tractography: A review of its clinical applications","volume":"8","author":"Yamada","year":"2009","journal-title":"Magn. Reson. Med. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.neuroscience.2018.06.028","article-title":"Synaptic Mitochondria are More Susceptible to Traumatic Brain Injury-induced Oxidative Damage and Respiratory Dysfunction than Non-synaptic Mitochondria","volume":"386","author":"Hill","year":"2018","journal-title":"Neuroscience"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Velmurugan, G.V., Vekaria, H.J., Rabchevsky, A.G., Saito, K., Morganti, J.M., Patel, S., Hubbard, B., and Sullivan, P.G. (2026). Neuronal Mitochondrial Dysfunction Drives Astrocytic Mitochondrial Transfer after TBI: Reveals the Therapeutic Potential of astrocytic EV-Mito. Res. Sq., rs.3.rs-10105855.","DOI":"10.21203\/rs.3.rs-10105855\/v1"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7205\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:40:39Z","timestamp":1789634439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":57,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187205"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187205","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}