Abstract
BACKGROUND: Disorders of consciousness (DoC) are a group of conditions that affect the level of awareness and communication in patients. While neuroimaging techniques can provide useful information about the brain structure and function in these patients, most existing methods rely on a single modality for analysis and rarely account for brain injury. To address these limitations, we propose a novel method that integrates two neuroimaging modalities, functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), to enhance the classification of subjects into different states of consciousness. METHOD AND RESULTS: The main contributions of our work are threefold: first, after constructing a dual-model individual graph using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we introduce a brain injury mask mechanism that consolidates damaged brain regions into a single graph node, enhancing the modeling of brain injuries and reducing deformation effects. Second, to address over-smoothing, we construct a dual-level graph that dynamically construct a population-level graph with node features from individual graphs, to promote the clustering of similar subjects while distinguishing dissimilar ones. Finally, we employ a subgraph exploration model with task-fMRI data to validate the interpretability of our model, confirming that the selected brain regions are task-relevant in cognition. Our experimental results on data from 89 healthy participants and 204 patients with DoC from Huashan Hospital, Fudan University, demonstrate that our method achieves high accuracy in classifying patients into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), or normal conscious state, outperforming current state-of-the-art methods. The explainability results of our method identified a subset of brain regions that are important for consciousness, such as the default mode network, the salience network, the dorsal attention network, and the visual network. Our method also revealed the relationship between brain networks and language processing in consciousness, and showed that language-related subgraphs can distinguish MCS from UWS patients. CONCLUSION: We proposed a novel graph learning method for classifying DoC based on fMRI and DTI data, introducing a brain injury mask mechanism to effectively handle damaged brains. The classification results demonstrate the effectiveness of our method in distinguishing subjects across different states of consciousness, while the explainability results identify key brain regions relevant to this classification. Our study provides new evidence for the role of brain networks and language processing in consciousness, with potential implications for improving the diagnosis and prognosis of patients with DoC.