Silva Stein, Peran Patrice, Kerhuel Lionel, Malagurski Briguita, Chauveau Nicolas, Bataille Benoit, Lotterie Jean Albert, Celsis Pierre, Aubry Florent, Citerio Giuseppe, Jean Betty, Chabanne Russel, Perlbarg Vincent, Velly Lionel, Galanaud Damien, Vanhaudenhuyse Audrey, Fourcade Olivier, Laureys Steven, Puybasset Louis
1Department of Anaesthesiology and Critical Care, Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France.2Critical Care and Anaesthesiology Department, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France.3Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France.4Department of Anaesthesiology and Critical Care, Critical Care Unit, Hopital Dieu Hospital, Narbonne, France.5Department of Anaesthesiology and Critical Care, School of medicine and Surgery, University Milano Bicocca and Hospital San Gerardo, Monza, Italy.6Department of Neuroradiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.7Department of Anaesthesiology and Critical Care, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.8Laboratoire d'Imagerie Biomédicale (UMR S 1146/UMR 7371), Université Pierre-et-Marie-Curie-Paris 06, Paris, France.9Critical Care and Anaesthesiology Department, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France.10Department of Neuroradiology, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France.11Cyclotron Research Center and Department of Neurology, University Hospital and University of Liège, Liège, Belgium.12Algology and Palliative Care Department, University Hospital and University of Liège, Liège, Belgium.
Crit Care Med. 2017 Aug;45(8):e763-e771. doi: 10.1097/CCM.0000000000002379.
We hypothesize that the combined use of MRI cortical thickness measurement and subcortical gray matter volumetry could provide an early and accurate in vivo assessment of the structural impact of cardiac arrest and therefore could be used for long-term neuroprognostication in this setting.
Prospective cohort study.
Five Intensive Critical Care Units affiliated to the University in Toulouse (France), Paris (France), Clermont-Ferrand (France), Liège (Belgium), and Monza (Italy).
High-resolution anatomical T1-weighted images were acquired in 126 anoxic coma patients ("learning" sample) 16 ± 8 days after cardiac arrest and 70 matched controls. An additional sample of 18 anoxic coma patients, recruited in Toulouse, was used to test predictive model generalization ("test" sample). All patients were followed up 1 year after cardiac arrest.
None.
Cortical thickness was computed on the whole cortical ribbon, and deep gray matter volumetry was performed after automatic segmentation. Brain morphometric data were employed to create multivariate predictive models using learning machine techniques. Patients displayed significantly extensive cortical and subcortical brain volumes atrophy compared with controls. The accuracy of a predictive classifier, encompassing cortical and subcortical components, has a significant discriminative power (learning area under the curve = 0.87; test area under the curve = 0.96). The anatomical regions which volume changes were significantly related to patient's outcome were frontal cortex, posterior cingulate cortex, thalamus, putamen, pallidum, caudate, hippocampus, and brain stem.
These findings are consistent with the hypothesis of pathologic disruption of a striatopallidal-thalamo-cortical mesocircuit induced by cardiac arrest and pave the way for the use of combined brain quantitative morphometry in this setting.
我们假设，联合使用MRI皮质厚度测量和皮质下灰质体积测定法，能够对心脏骤停的结构影响进行早期、准确的体内评估，因此可用于此情况下的长期神经预后评估。
前瞻性队列研究。
隶属于法国图卢兹大学、法国巴黎大学、法国克莱蒙费朗大学、比利时列日大学和意大利蒙扎大学的五个重症监护病房。
对126名心脏骤停后16±8天处于缺氧昏迷状态的患者（“学习”样本）以及70名匹配的对照者进行了高分辨率解剖T1加权成像。另外从图卢兹招募了18名缺氧昏迷患者样本，用于测试预测模型的泛化能力（“测试”样本）。所有患者在心脏骤停后均接受了1年的随访。
无。
计算整个皮质带的皮质厚度，并在自动分割后进行深部灰质体积测定。利用机器学习技术，采用脑形态测量数据创建多变量预测模型。与对照组相比，患者的皮质和皮质下脑体积出现了明显的广泛萎缩。包含皮质和皮质下成分的预测分类器的准确性具有显著的判别力（学习样本曲线下面积=0.87；测试样本曲线下面积=0.96）。体积变化与患者预后显著相关的解剖区域为额叶皮质、后扣带回皮质、丘脑、壳核、苍白球、尾状核、海马体和脑干。
这些发现与心脏骤停引起的纹状体苍白球 - 丘脑 - 皮质中脑回路病理破坏的假设一致，并为在此情况下使用联合脑定量形态测量法铺平了道路。
