From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.).
Radiology. 2018 Apr;287(1):247-255. doi: 10.1148/radiol.2017162161. Epub 2017 Oct 18.
Purpose To assess whether early brain functional connectivity is associated with functional recovery 1 year after cardiac arrest (CA). Materials and Methods Enrolled in this prospective multicenter cohort were 46 patients who were comatose after CA. Principal outcome was cerebral performance category at 12 months, with favorable outcome (FO) defined as cerebral performance category 1 or 2. All participants underwent multiparametric structural and functional magnetic resonance (MR) imaging less than 4 weeks after CA. Within- and between-network connectivity was measured in dorsal attention network (DAN), default-mode network (DMN), salience network (SN), and executive control network (ECN) by using seed-based analysis of resting-state functional MR imaging data. Structural changes identified with fluid-attenuated inversion recovery and diffusion-weighted imaging sequences were analyzed by using validated morphologic scales. The association between connectivity measures, structural changes, and the principal outcome was explored with multivariable modeling. Results Patients underwent MR imaging a mean 12.6 days ± 5.6 (standard deviation) after CA. At 12 months, 11 patients had an FO. Patients with FO had higher within-DMN connectivity and greater anticorrelation between SN and DMN and between SN and ECN compared with patients with unfavorable outcome, an effect that was maintained after multivariable adjustment. Anticorrelation of SN-DMN predicted outcomes with higher accuracy than fluid-attenuated inversion recovery or diffusion-weighted imaging scores (area under the receiver operating characteristic curves, respectively, 0.88, 0.74, and 0.71). Conclusion MR imaging-based measures of cerebral functional network connectivity obtained in the acute phase of CA were independently associated with FO at 1 year, warranting validation as early markers of long-term recovery potential in patients with anoxic-ischemic encephalopathy. RSNA, 2017.
评估心脏骤停（CA）后昏迷患者 1 年内早期脑功能连接是否与功能恢复相关。
本前瞻性多中心队列研究纳入了 46 例 CA 后昏迷患者。主要结局为 12 个月时的脑功能预后评分（cerebral performance category，CPC），良好预后（favorable outcome，FO）定义为 CPC 1 或 2 分。所有患者在 CA 后 4 周内均行多参数结构和功能磁共振（magnetic resonance，MR）成像。采用静息态功能 MR 成像数据的种子点分析测量背侧注意网络（dorsal attention network，DAN）、默认模式网络（default-mode network，DMN）、突显网络（salience network，SN）和执行控制网络（executive control network，ECN）的网络内和网络间连接。采用已验证的形态学量表分析液体衰减反转恢复和弥散加权成像序列识别的结构变化。采用多变量模型探讨连接测量值、结构变化与主要结局的相关性。
患者 CA 后行 MR 成像的平均时间为 12.6 ± 5.6（标准差）天。12 个月时，11 例患者 FO。与预后不良者相比，FO 患者的 DMN 网络内连接更高，SN 与 DMN 和 SN 与 ECN 之间的反向连接更大，这种效应在多变量校正后仍存在。SN-DMN 反向连接预测结局的准确性高于液体衰减反转恢复或弥散加权成像评分（受试者工作特征曲线下面积分别为 0.88、0.74 和 0.71）。
CA 急性期基于 MR 成像的脑功能网络连接测量与 1 年时 FO 独立相关，作为缺氧缺血性脑病患者长期恢复潜力的早期标志物值得进一步验证。
放射学会，2017 年。
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