Goto Y, Wataya T, Arakawa Y, Hojo M, Chin M, Yamagata S, Kikuta K, Ishii A
Department of Neurosurgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-0052, Japan.
No To Shinkei. 2001 Jun;53(6):535-40.
The purpose of this study was to describe the findings of sequential magnetic resonance imaging (MRI) in postresuscitation encephalopathy. Although its outcome is known to be overwhelming, but its acute findings by variable imaging methods are subtle and show only limited values. The correlation of the findings of MRI with clinical outcome were also analyzed.
Twelve patients with global cerebral anoxia who underwent MRI with conventional and diffusion-weighted imaging were enrolled in this study. Compared with normal MRI images, abnormal signal regions were checked and described in cortex, basal ganglia and white matter. Also medical records were carefully reviewed to study the cause, the time necessary for resuscitation and long term clinical outcome.
The earliest finding was obtained by diffusion-weighted image less than 24 hours (acute period) in bilateral cerebral cortex as bright high signal intensity regions. Similar abnormality of bright high signal area in FLAIR and T 2 was followed according to the time elapsed in early subacute period (1-13 days). Succeedingly, white matter was involved and laminar necrosis in cortical area was observed in late subacute period (14-20 days). Finally, diffuse brain atrophy and obtundation of gray-white matter junction were seen in chronic stage (after 21 days). These MR findings were coincided well with histopathological findings reported in literatures. The poor outcome was closely and significantly correlated with abnormality in MR images.
MRI was a useful diagnostic modality to diagnose the whole brain ischemic encephalopathy and to predict the prognosis.
本研究旨在描述复苏后脑病连续磁共振成像（MRI）的结果。尽管已知其预后极差，但其通过多种成像方法得出的急性期表现细微，价值有限。本研究还分析了MRI表现与临床预后的相关性。
本研究纳入了12例接受常规及弥散加权成像MRI检查的全脑缺氧患者。将异常信号区域与正常MRI图像对比，观察并描述皮质、基底节和白质的情况。同时仔细查阅病历，研究病因、复苏所需时间及长期临床预后。
最早的表现是在双侧大脑皮质于24小时内（急性期）的弥散加权图像上出现明亮的高信号区。在亚急性期早期（1 - 13天），随着时间推移，FLAIR和T2加权像上也出现类似的明亮高信号区异常。随后，在亚急性期晚期（14 - 20天）白质受累，皮质区出现层状坏死。最后，在慢性期（21天以后）可见弥漫性脑萎缩及灰白质交界模糊。这些MRI表现与文献报道的组织病理学结果高度吻合。不良预后与MRI图像异常密切相关且具有显著相关性。
MRI是诊断全脑缺血性脑病及预测预后的有用诊断方法。
