Shankar Jai Jai Shiva, Stewart-Perrin Brandie, Quraishi Ata-Ur-Rehman, Bata Iqbal, Vandorpe Robert
Department of Diagnostic Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
Department of Diagnostic Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
Am J Cardiol. 2018 Apr 1;121(7):874-878. doi: 10.1016/j.amjcard.2017.12.027. Epub 2018 Jan 9.
Early assessment of the potential for neurologic recovery in comatose cardiac arrest patients (CCAP) has been a challenge despite significant evolution in management and imaging techniques. The purpose of study was to determine if the use of computed tomography perfusion (CTP) in CCAPs is feasible and if this technique can predict the likelihood that CCAPs will have a devastating outcome at hospital discharge. We prospectively enrolled 10 newly admitted comatose adults who had an out-of-hospital cardiac arrest and were treated with standard therapeutic hypothermia protocols. Patients underwent CTP of the head within 6 hours after finishing therapeutic hypothermia treatment. The imaging findings were compared with the results of a clinical assessment, as well as the modified Rankin Scale (mRS) score at hospital discharge. Sensitivity, specificity, and positive and negative predictive values for CTP were calculated to predict clinical outcome. Eight patients had an mRS score of ≥5, and 2 patients had an mRS score of ≤2 at hospital discharge. CTP predicted a good clinical outcome in both patients with an mRS score of ≤2. The area under the curve (AUC) for plain computed tomography of the head, computerized tomography angiogram 4-point scale, computerized tomography angiogram 7-point scale, CTP of the whole brain, and CTP of the brainstem for predicting the results of the immediate clinical assessment were 0.76, 0.83, 0.67, 0.83, and 1.0, respectively. The AUCs for predicting outcome at discharge were 0.69, 0.63, 0.56, 0.63, 0.63, and 0.69, respectively. In conclusion, our pilot study showed that CTP is feasible and had a very high AUC for predicting the results of immediate clinical assessment in CCAP.
尽管在治疗和成像技术方面取得了显著进展，但对昏迷心脏骤停患者（CCAP）神经功能恢复潜力的早期评估一直是一项挑战。本研究的目的是确定在CCAP中使用计算机断层扫描灌注（CTP）是否可行，以及该技术能否预测CCAP患者出院时出现灾难性结局的可能性。我们前瞻性地纳入了10名新入院的昏迷成人，他们均发生过院外心脏骤停，并接受了标准的治疗性低温方案治疗。患者在完成治疗性低温治疗后6小时内接受头部CTP检查。将影像学检查结果与临床评估结果以及出院时的改良Rankin量表（mRS）评分进行比较。计算CTP预测临床结局的敏感性、特异性、阳性预测值和阴性预测值。8例患者出院时mRS评分≥5，2例患者出院时mRS评分≤2。CTP预测mRS评分≤2的两名患者均有良好的临床结局。头部平扫计算机断层扫描、计算机断层血管造影4分法、计算机断层血管造影7分法、全脑CTP和脑干CTP预测即时临床评估结果的曲线下面积（AUC）分别为0.76、0.83、0.67、0.83和1.0。预测出院结局的AUC分别为0.69、0.63、0.56、0.63、0.63和0.69。总之，我们的初步研究表明，CTP是可行的，并且在预测CCAP即时临床评估结果方面具有非常高的AUC。
