Department for Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, SR-21000, Serbia.
Neuroradiology. 2021 Oct;63(10):1651-1658. doi: 10.1007/s00234-021-02663-5. Epub 2021 Mar 1.
Over the years, interesting SWI abnormalities in patients from intensive care units (ICU) were observed, not attributable to a specific cause and with uncertain clinical significance. Recently, multiple SWI-hypointense foci were mentioned related to neurological complications of SARS-COV-2 infection. The purpose of the study was to describe the patterns of susceptibility brain changes in critically-ill patients who underwent mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO).
An institutional board-approved, retrospective study was conducted on 250 ICU patients in whom brain MRI was performed between January 2011 and May 2020. Out of 48 patients who underwent mechanical ventilation/ECMO, in fifteen patients (median age 47.7 years), the presence of SWI abnormalities was observed and described.
Microsusceptibilities were located in white-gray matter interface, in subcortical white matter (U-fibers), and surrounding subcortical nuclei in 13/14 (92,8%) patients. In 8/14 (57,1%) patients, SWI foci were seen infratentorially. The corpus callosum was affected in ten (71,4%), internal capsule in five (35,7%), and midbrain/pons in six (42,8%) patients.
We showed distinct patterns of diffuse brain SWI susceptibilities in critically-ill patients who underwent mechanical ventilation/ECMO. The etiology of these foci remains uncertain, but the association with mechanical ventilation, prolonged respiratory failure, and hypoxemia seems probable explanations.
多年来，在重症监护病房（ICU）的患者中观察到了有趣的 SWI 异常，这些异常不能归因于特定原因，且其临床意义不确定。最近，提到了与 SARS-COV-2 感染的神经系统并发症相关的多个 SWI 低信号灶。本研究的目的是描述接受机械通气和/或体外膜氧合（ECMO）的危重症患者的大脑易感性变化模式。
对 2011 年 1 月至 2020 年 5 月期间在 ICU 进行脑部 MRI 的 250 例患者进行了机构委员会批准的回顾性研究。在接受机械通气/ECMO 的 48 例患者中，有 15 例（中位年龄 47.7 岁）患者观察到并描述了 SWI 异常的存在。
在 14 例患者中（92.8%），微敏感性位于灰白质界面、皮质下白质（U 纤维）和皮质下核周围。在 8 例患者中（57.1%），SWI 灶可见于小脑幕下。10 例（71.4%）患者的胼胝体受累，5 例（35.7%）内囊受累，6 例（42.8%）中脑/脑桥受累。
我们展示了接受机械通气/ECMO 的危重症患者大脑弥散性 SWI 易感性的独特模式。这些病灶的病因仍不确定，但与机械通气、呼吸衰竭延长和低氧血症的关联似乎是合理的解释。
