Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
Crit Care. 2023 Jan 13;27(1):16. doi: 10.1186/s13054-023-04305-z.
This study aimed to investigate the association between ultra-early (within 6 h after return of spontaneous circulation [ROSC]) brain diffusion-weighted magnetic resonance imaging (DW-MRI) and neurological outcomes in comatose survivors after out-of-hospital cardiac arrest.
We conducted a registry-based observational study from May 2018 to February 2022 at a Chungnam national university hospital in Daejeon, Korea. Presence of high-signal intensity (HSI) (P) was defined as a HSI on DW-MRI with corresponding hypoattenuation on the apparent diffusion coefficient map irrespective of volume after hypoxic ischemic brain injury; absence of HSI was defined as A. The primary outcome was the dichotomized cerebral performance category (CPC) at 6 months, defined as good (CPC 1-2) or poor (CPC 3-5).
Of the 110 patients (30 women [27.3%]; median (interquartile range [IQR]) age, 58 [38-69] years), 48 (43.6%) had a good neurological outcome, time from ROSC to MRI scan was 2.8 h (IQR 2.0-4.0 h), and the P on DW-MRI was observed in 46 (41.8%) patients. No patients in the P group had a good neurological outcome compared with 48 (75%) patients in the A group. In the A group, cerebrospinal fluid (CSF) neuron-specific enolase (NSE) levels were significantly lower in the group with good neurological outcome compared to the group with poor neurological outcome (20.1 [14.4-30.7] ng/mL vs. 84.3 [32.4-167.0] ng/mL, P < 0.001). The area under the curve for P on DW-MRI was 0.87 (95% confidence interval [CI] 0.80-0.93), and the specificity and sensitivity for predicting a poor neurological outcome were 100% (95% CI 91.2%-100%) and 74.2% (95% CI 62.0-83.5%), respectively. A higher sensitivity was observed when CSF NSE levels were combined (88.7% [95% CI 77.1-95.1%]; 100% specificity).
In this cohort study, P findings on ultra-early DW-MRI were associated with poor neurological outcomes 6 months following the cardiac arrest. The combined CSF NSE levels showed higher sensitivity at 100% specificity than on DW-MRI alone. Prospective multicenter studies are required to confirm these results.
本研究旨在探讨院外心脏骤停后昏迷幸存者超早期（ROSC 后 6 小时内）脑弥散加权磁共振成像（DW-MRI）与神经结局之间的关系。
我们在韩国大田市忠南国立大学医院进行了一项基于登记的观察性研究，时间为 2018 年 5 月至 2022 年 2 月。高信号强度（HSI）（P）的存在定义为缺氧缺血性脑损伤后 DW-MRI 上存在 HSI，相应的表观弥散系数图上存在低信号强度，无论体积如何；无 HSI 定义为 A。主要结局是 6 个月时的二分法脑功能分类（CPC），定义为良好（CPC 1-2）或不良（CPC 3-5）。
在 110 名患者（30 名女性[27.3%]；中位（四分位距[IQR]）年龄，58 [38-69]岁）中，48 名（43.6%）有良好的神经结局，ROSC 至 MRI 扫描的时间为 2.8 小时（IQR 2.0-4.0 小时），46 名（41.8%）患者在 DW-MRI 上出现 P。与 A 组中 48 名（75%）有良好神经结局的患者相比，P 组中没有患者有良好的神经结局。在 A 组中，与神经结局不良组相比，神经特异性烯醇化酶（NSE）水平在神经结局良好组中显著降低（20.1[14.4-30.7]ng/ml 比 84.3[32.4-167.0]ng/ml，P<0.001）。DW-MRI 上 P 的曲线下面积为 0.87（95%置信区间 [CI] 0.80-0.93），预测不良神经结局的特异性和敏感性分别为 100%（95%CI 91.2%-100%）和 74.2%（95%CI 62.0%-83.5%）。当结合脑脊液 NSE 水平时，敏感性更高（88.7%[95%CI 77.1%-95.1%]；100%特异性）。
在这项队列研究中，心脏骤停后超早期 DW-MRI 上的 P 发现与 6 个月后的不良神经结局相关。与 DW-MRI 相比，结合 CSF NSE 水平的检测具有更高的敏感性（100%特异性）。需要前瞻性多中心研究来证实这些结果。
