Neuroimaging of Disorder of Consciousness: From Brain Network Mechanisms to Clinical Translation

Consciousness is central to the human condition, but its inherent characteristics and underlying mechanisms remain poorly understood. Advances in neuroscience based on the concept of the vegetative state have expanded the understanding of disorders of consciousness (DoC), particularly the minimally conscious state (MCS) and emergence from the MCS. Despite this progress, diagnostic uncertainty persists due to the subtlety of clinical signs and variable outcomes. Although standardized behavioral scales remain the gold standard for diagnosing DoC, advanced imaging and electrophysiological tools increasingly highlight the importance of multimodal assessments. These approaches have demonstrated that patients who appear unresponsive in behavioral assessments may voluntarily engage in mental activities that can be detected using functional magnetic resonance imaging and electroencephalography, potentially revealing covert consciousness and suggesting possible therapeutic strategies. This review consolidates the current evidence on the diagnosis, prognosis, and mechanisms of DoC across various neurological conditions. We highlight the role of brain networks in producing diverse phenotypes as well as the need for well-designed studies that can improve multimodal diagnostic strategies. Building on recent initiatives aimed at standardizing definitions, prognostic guidelines, data collection, and clinical management practices, we show that further multimodal neuroimaging research is essential to improving diagnoses, prognostication, and outcomes for patients with DoC and their families.