Department of Neurology, Rijnstate Hospital, 6800 TA Arnhem, the Netherlands; Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, 6500 HC Nijmegen, the Netherlands.
Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, 6500 HC Nijmegen, the Netherlands.
Neuroimage Clin. 2022;36:103171. doi: 10.1016/j.nicl.2022.103171. Epub 2022 Aug 26.
Current multimodal approaches leave approximately half of the comatose patients after cardiac arrest with an indeterminate prognosis. Here we investigated whether early MRI markers of brain network integrity can distinguish between comatose patients with a good versus poor neurological outcome six months later.
We performed a prospective cohort study in 48 patients after cardiac arrest submitted in a comatose state to the Intensive Care Unit of two Dutch hospitals. MRI was performed at three days after cardiac arrest, including resting state functional MRI and diffusion-tensor imaging (DTI). Resting state fMRI was used to quantify functional connectivity within ten resting-state networks, and DTI to assess mean diffusivity (MD) in these same networks. We contrasted two groups of patients, those with good (n = 29, cerebral performance category 1-2) versus poor (n = 19, cerebral performance category 3-5) outcome at six months. Mutual associations between functional connectivity, MD, and clinical outcome were studied.
Patients with good outcome show higher within-network functional connectivity (fMRI) and higher MD (DTI) than patients with poor outcome across 8/10 networks, most prominent in the default mode network, salience network, and visual network. While the anatomical distribution of outcome-related changes was similar for functional connectivity and MD, the pattern of inter-individual differences was very different: functional connectivity showed larger inter-individual variability in good versus poor outcome, while the opposite was observed for MD. Exploratory analyses suggested that it is possible to define network-specific cut-off values that could help in outcome prediction: (1) high functional connectivity and high MD, associated with good outcome; (2) low functional connectivity and low MD, associated with poor outcome; (3) low functional connectivity and high MD, associated with uncertain outcome.
Resting-state functional connectivity and mean diffusivity-three days after cardiac arrest are strongly associated with neurological recovery-six months later in a complementary fashion. The combination of fMRI and MD holds potential to improve prediction of outcome.
目前的多模态方法大约将一半的心脏骤停后处于昏迷状态的患者预后不确定。在这里，我们研究了在心脏骤停后昏迷状态下被送入荷兰两家医院重症监护病房的 48 名患者中，早期脑网络完整性的 MRI 标志物是否可以区分 6 个月后神经功能预后良好与预后不良的患者。
我们对 48 名心脏骤停后昏迷状态的患者进行了前瞻性队列研究，这些患者被送入荷兰两家医院的重症监护病房。MRI 检查在心脏骤停后 3 天进行，包括静息态功能 MRI 和弥散张量成像（DTI）。静息态 fMRI 用于量化 10 个静息态网络内的功能连接，DTI 用于评估这些网络中的平均弥散度（MD）。我们对比了两组患者，6 个月后预后良好（n=29，脑功能分类 1-2）与预后不良（n=19，脑功能分类 3-5）的患者。研究了功能连接、MD 与临床结局之间的相互关联。
预后良好的患者在 8/10 个网络中表现出比预后不良患者更高的网络内功能连接（fMRI）和更高的 MD（DTI），在默认模式网络、突显网络和视觉网络中最为明显。虽然功能连接和 MD 的与结局相关的改变的解剖分布相似，但个体间差异的模式却大不相同：功能连接在预后良好的个体间变化更大，而 MD 则相反。探索性分析表明，定义特定于网络的截断值可能有助于预测结局：（1）高功能连接和高 MD，与良好的结局相关；（2）低功能连接和低 MD，与不良的结局相关；（3）低功能连接和高 MD，与不确定的结局相关。
心脏骤停后 3 天的静息态功能连接和平均弥散度与 6 个月后的神经恢复高度相关，两者以互补的方式相关。fMRI 和 MD 的结合有可能提高结局预测的准确性。
