Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Resuscitation. 2011 May;82(5):549-55. doi: 10.1016/j.resuscitation.2011.01.018. Epub 2011 Mar 1.
Prognostication may be difficult in comatose cardiac arrest survivors. Magnetic resonance imaging (MRI) is potentially useful in the prediction of neurological outcome, and it may detect acute ischemia at an early stage. In a pilot setting we determined the prevalence and development of cerebral ischemia using serial MRI examinations and neurological assessment.
Ten witnessed out-of-hospital cardiac arrest patients were included. MRI was carried out approximately 2h after admission to the hospital, repeated after 24h of therapeutic hypothermia and 96 h after the arrest. The images were assessed for development of acute ischemic lesions. Neurophysiological and cognitive tests as well as a self-reported quality-of-life questionnaire, Short Form-36 (SF-36), were administered minimum 12 months after discharge.
None of the patients had acute cerebral ischemia on MRI at admission. Three patients developed ischemic lesions after therapeutic hypothermia. There was a change in the apparent diffusion coefficient, which significantly correlated with the temperature (p < 0.001). The neurophysiological tests appeared normal. The patients scored significantly better on SF 36 than the controls as regards both bodily pain (p = 0.023) and mental health (p = 0.016).
MRI performed in an early phase after cardiac arrest has limitations, as MRI performed after 24 and 96 h revealed ischemic lesions not detectable on admission. ADC was related to the core temperature, and not to the volume distributed intravenously. Follow-up neurophysiologic tests and self-reported quality of life were good.
昏迷心脏骤停幸存者的预后可能较为困难。磁共振成像（MRI）在预测神经功能预后方面可能具有一定作用，并且它可以早期发现急性缺血。在一项试点研究中，我们通过连续 MRI 检查和神经评估来确定脑缺血的发生率和发展情况。
纳入 10 例院外目击心脏骤停患者。入院后约 2h 进行 MRI 检查，在复温 24h 和心脏骤停后 96h 重复检查。评估图像是否存在急性缺血性病变。进行神经生理和认知测试，以及自我报告的生活质量问卷（Short Form-36，SF-36），在出院后至少 12 个月进行评估。
入院时，无患者的 MRI 显示有急性脑缺血。复温后有 3 例患者出现缺血性病变。表观弥散系数（apparent diffusion coefficient，ADC）发生变化，与温度呈显著相关（p < 0.001）。神经生理测试结果正常。患者在 SF-36 上的身体疼痛（p = 0.023）和心理健康（p = 0.016）两个方面的评分均明显优于对照组。
心脏骤停后早期进行 MRI 检查具有一定局限性，因为在 24h 和 96h 后进行 MRI 检查时，发现了入院时未检出的缺血性病变。ADC 与核心温度相关，与静脉内分布的容量无关。随访神经生理测试和自我报告的生活质量良好。
