Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
Resuscitation. 2010 May;81(5):534-8. doi: 10.1016/j.resuscitation.2010.01.012. Epub 2010 Mar 1.
Although computed tomography (CT) signs of ischaemia, including loss of boundary (LOB) between grey matter and white matter and cortical sulcal effacement, in cardiac arrest (CA) survivors are known, their temporal profile and prognostic significance remains unclear; their clarification is necessary.
Brain CT scans were obtained immediately after resuscitation in 75 non-traumatic CA survivors in a prospective fashion. They were divided into two groups according to the CA-return of spontaneous circulation (ROSC) interval: < or =20 min vs. >20 min. The incidence of the CT signs and predictability of these signs for outcome, assessed 6 months after CA, was evaluated and compared.
The incidence of the positive LOB sign was 24% in the < or =20-min group and 83% in the >20-min group, and the difference was statistically significant (p<0.001). The interval of 20 min seemed to be the time window for the LOB development. The incidence of the positive sulcal effacement sign was 0% in the < or =20 min group and 34% in the >20-min group, and the difference was statistically significant (p=0.004). A positive LOB sign was predictive of unfavourable outcome with an 81% sensitivity and 92% specificity. A positive sulcal effacement sign was predictive of unfavourable outcome with a 32% sensitivity and 100% specificity.
A time window may exist for ischaemic CT signs in CA survivors. The LOB sign may develop when the CA-ROSC interval exceeds 20 min, whereas the sulcal effacement sign may develop later. However, their temporal profile and outcome predictability should be verified by multicentre studies.
尽管在心脏骤停（CA）幸存者中已知存在缺血的计算机断层扫描（CT）征象，包括灰质和白质之间边界的丧失（LOB）和皮质脑沟变平，但它们的时间过程和预后意义仍不清楚；阐明这一点是必要的。
前瞻性地对 75 例非创伤性 CA 幸存者进行了复苏后即刻的脑部 CT 扫描。根据 CA-自主循环恢复（ROSC）的间隔，将他们分为两组：< 或 =20 分钟和>20 分钟。评估和比较了 CT 征象的发生率和这些征象对 CA 后 6 个月结局的预测能力。
在< 或 =20 分钟组中，阳性 LOB 征的发生率为 24%，而在>20 分钟组中为 83%，差异具有统计学意义（p<0.001）。20 分钟的间隔似乎是 LOB 发展的时间窗口。在< 或 =20 分钟组中，阳性脑沟变平征的发生率为 0%，而在>20 分钟组中为 34%，差异具有统计学意义（p=0.004）。阳性 LOB 征对不良结局有预测作用，其敏感性为 81%，特异性为 92%。阳性脑沟变平征对不良结局有预测作用，其敏感性为 32%，特异性为 100%。
在 CA 幸存者中可能存在缺血性 CT 征象的时间窗口。当 CA-ROSC 间隔超过 20 分钟时，可能会出现 LOB 征，而脑沟变平征可能会在较晚时出现。然而，它们的时间过程和预后预测能力应通过多中心研究来验证。
