Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Department of Radiology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
J Neuroradiol. 2021 Sep;48(5):379-384. doi: 10.1016/j.neurad.2020.12.001. Epub 2020 Dec 17.
This study aimed to assess the global impairment and prognostic performance of cerebral perfusions (CP) measured by dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) in out-of-hospital cardiac arrest (OHCA) patients after sustained restoration of spontaneous circulation (ROSC).
This is a single-centre, prospective observational study. OHCA patients performed DSC-PWI within 8 h after ROSC were enrolled. We quantified the CP parameters, such as cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP), and time to maximum of the residue function (Tmax) either by normalization or arterial input function (AIF). The primary and secondary outcomes were survival to discharge and comparison of prognostic performance between CP parameters and serum neuron-specific enolase (NSE) using area under the receiver operating characteristic (AUROC) and sensitivity values.
Thirty-one patients were included in this study. CBV and TTP quantified by normalization, and MTT and Tmax quantified by AIF showed significantly higher CP values in the non-survival group (p = 0.02, 0.03, 0.02, and <0.01, respectively). Their AUROCs and 100% specific sensitivities were 0.74/25.0%, 0.60/33.3%, 0.75/56.3%, and 0.79/43.8%, respectively. MTT quantified by AIF showed sensitivity in predicting mortality at an early stage of PCA care, comparable with NSE.
Hyperaemia and delayed CP were generally observed in OHCA patients regardless of outcomes. MTT and Tmax quantified by AIF have prognostic performance in predicting mortality, comparable with NSE. Further prospective multicentre studies are required to confirm our results.
本研究旨在评估动态磁敏感对比灌注加权成像（DSC-PWI）测量的脑灌注（CP）在恢复自主循环（ROSC）后院外心脏骤停（OHCA）患者中的整体损伤程度和预后表现。
这是一项单中心前瞻性观察性研究。OHCA 患者在 ROSC 后 8 小时内进行 DSC-PWI。我们通过标准化或动脉输入函数（AIF）定量 CP 参数，如脑血容量（CBV）、脑血流量（CBF）、平均通过时间（MTT）、达峰时间（TTP）和残差功能最大时间（Tmax）。主要和次要结局是出院时的存活率以及通过接受者操作特征（AUROC）曲线下面积和灵敏度值比较 CP 参数与神经元特异性烯醇化酶（NSE）的预后表现。
本研究共纳入 31 例患者。标准化后定量的 CBV 和 TTP，以及 AIF 定量的 MTT 和 Tmax，在非存活组的 CP 值明显较高（p=0.02，0.03，0.02 和 <0.01）。其 AUROC 和 100%特异灵敏度分别为 0.74/25.0%、0.60/33.3%、0.75/56.3%和 0.79/43.8%。通过 AIF 定量的 MTT 在预测 PCA 护理早期死亡率方面具有灵敏度，与 NSE 相当。
OHCA 患者无论结局如何，通常都存在充血和 CP 延迟。通过 AIF 定量的 MTT 和 Tmax 在预测死亡率方面具有与 NSE 相当的预后表现。需要进一步进行前瞻性多中心研究来证实我们的结果。
