Resting-State Functional MRI and Clinical Outcomes After Acute Disorders of Consciousness: A Systematic Review.

In 30 seconds

This systematic review examined whether resting-state functional MRI (rs-fMRI) measures during the acute phase of severe brain injury are associated with outcomes in adults with disorders of consciousness. Thirty studies involving 800 patients scanned within 28 days of injury were included; imaging occurred a weighted average of 9.31 days after intensive care unit admission. Across studies, rs-fMRI measures were consistently associated with neurologic or functional outcomes, most often assessed at discharge or 3–12 months after injury. The findings suggest potential prognostic value, but do not establish that rs-fMRI improves prediction or clinical decisions.

Key findings

• Thirty eligible studies included 800 adults with acute disorders of consciousness; mean age was 48 years and 69% were male.
• Patients were scanned a weighted average of 9.31 days after intensive care unit admission.
• Studies consistently reported associations between rs-fMRI measures and neurologic or functional outcomes, despite methodological heterogeneity.
• The default mode network was assessed most often (n = 20), followed by executive control networks (n = 11).

Why it matters

Prognostication after severe brain injury is challenging, and rs-fMRI offers a way to assess large-scale network integrity without external stimulation. The consistent associations reported across studies support further evaluation of this approach as a potential source of prognostic information. However, association alone does not show that imaging improves outcome prediction or patient management.

What to keep in mind

The review reports substantial heterogeneity and small sample sizes across studies, limiting comparability. Larger prospective studies and standardized acquisition and analysis are needed.