Department of Neurology at Yale University School of Medicine, New Haven, Connecticut; Department of Neurology at Massachusetts General Hospital, Boston.
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):899-905. doi: 10.1016/j.jstrokecerebrovasdis.2012.08.006. Epub 2012 Sep 18.
The role of neuroimaging in assessing prognosis in comatose cardiac survivors appears promising, but little is known regarding the import of particular spatial patterns. We report a specific spatial imaging abnormality on magnetic resonance imaging (MRI) that portends a poor prognosis: bilateral hippocampal hyperintensities on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences.
Eighty sequential comatose cardiac arrest patients underwent MRI scans. Qualitative and quantitative regional analyses were performed. Patients were categorized as HIPPO(+) (n = 18) or HIPPO(-) (n = 62) based on whether they had bilateral hippocampal hyperintensities. Poor outcome was defined by a modified Rankin Scale (mRS) score ≥4 at 6 months.
Patients with bilateral hippocampal abnormalities had a higher frequency of poor outcome (P = .032). HIPPO(+) patients suffered more severe cerebral injury, with lower whole brain apparent diffusion coefficient values (P = .043) and a greater number of affected regions on DWI (P = .001) and FLAIR (P = .001) than HIPPO(-) patients. The hippocampal approach was 100% specific for a poor prognosis; only 1 patient survived and remained in a vegetative state.
Bilateral hippocampal hyperintensities on MRI may be a specific imaging finding that is indicative of poor prognosis in patients who suffer global hypoxic-ischemic injury. More research on the prognostic significance of this and similar neuroimaging patterns is indicated.
神经影像学在评估昏迷性心脏骤停幸存者的预后方面具有很大的潜力，但对于特定空间模式的重要性知之甚少。我们报告了一种特定的磁共振成像（MRI）空间成像异常，这种异常预示着预后不良：弥散加权成像（DWI）和液体衰减反转恢复（FLAIR）序列上双侧海马高信号。
80 例连续昏迷性心脏骤停患者接受 MRI 扫描。进行了定性和定量的区域分析。根据是否存在双侧海马高信号，将患者分为 HIPPO（+）（n=18）或 HIPPO（-）（n=62）。不良预后定义为 6 个月时改良 Rankin 量表（mRS）评分≥4。
双侧海马异常患者不良预后发生率较高（P=0.032）。HIPPO（+）患者的脑损伤更严重，全脑表观弥散系数值较低（P=0.043），DWI（P=0.001）和 FLAIR（P=0.001）上受影响的区域较多。海马方法对预后不良具有 100%的特异性；只有 1 例患者存活并仍处于植物状态。
MRI 上双侧海马高信号可能是一种特定的影像学表现，表明全身缺氧缺血性损伤患者的预后不良。需要进一步研究这种和类似神经影像学模式的预后意义。
