Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Resuscitation. 2023 Jun;187:109761. doi: 10.1016/j.resuscitation.2023.109761. Epub 2023 Mar 9.
This study evaluated the association between the extent of diffusion restriction on brain diffusion-weighted imaging (DWI) and neurological outcomes in patients who underwent targeted temperature management (TTM) after an out-of-hospital cardiac arrest (OHCA).
Patients who underwent brain magnetic resonance imaging within 10 days of OHCA between 2012 and 2021 were analysed. The extent of diffusion restriction was described according to the modified DWI Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS). The 35 predefined brain regions were assigned a score if diffuse signal changes were concordantly present in DWI scans and apparent diffusion coefficient maps. The primary outcome was an unfavourable neurological outcome at 6 months. The sensitivity, specificity, and receiver operating characteristic (ROC) curves for the measured parameters were analysed. Cut-off values were determined to predict the primary outcome. The predictive cut-off DWI-ASPECTS was internally validated using five-fold cross-validation.
Of the 301 patients, 108 (35.9%) had 6-month favourable neurological outcomes. Patients with unfavourable outcomes had higher whole-brain DWI-ASPECTS (median, 31 [26-33] vs. 0 [0-1], P < 0.001) than those with favourable outcomes. The area under the ROC curve (AUROC) of whole-brain DWI-ASPECTS was 0.957 (95% confidence interval [CI] 0.928-0.977). A cut-off value of ≥8 for unfavourable neurological outcomes had specificity and sensitivity of 100% (95% CI 96.6-100) and 89.6% (95% CI 84.4-93.6), respectively. The mean AUROC was 0.956.
More extensive diffusion restriction on DWI-ASPECTS in patients with OHCA who underwent TTM was associated with 6-month unfavourable neurological outcomes. Running title: Diffusion restriction and neurological outcomes after cardiac arrest.
本研究评估了院外心脏骤停（OHCA）后行目标温度管理（TTM）患者的脑弥散加权成像（DWI）弥散受限程度与神经结局之间的关系。
分析了 2012 年至 2021 年 OHCA 后 10 天内行脑磁共振成像的患者。根据改良的 DWI 阿尔伯塔卒中计划早期计算机断层扫描评分（DWI-ASPECTS）描述弥散受限程度。如果在 DWI 扫描和表观弥散系数图中均存在弥漫性信号改变，则将 35 个预先定义的脑区分配一个分数。主要结局为 6 个月时不良神经结局。分析了测量参数的敏感性、特异性和受试者工作特征（ROC）曲线。确定截断值以预测主要结局。采用五重交叉验证对预测截断 DWI-ASPECTS 进行内部验证。
在 301 例患者中，108 例（35.9%）有 6 个月时的良好神经结局。不良结局患者的全脑 DWI-ASPECTS 更高（中位数，31 [26-33] 比 0 [0-1]，P<0.001）。全脑 DWI-ASPECTS 的 ROC 曲线下面积（AUROC）为 0.957（95%置信区间 [CI] 0.928-0.977）。截断值≥8 预测不良神经结局的特异性和敏感性分别为 100%（95%CI 96.6-100）和 89.6%（95%CI 84.4-93.6）。平均 AUROC 为 0.956。
行 TTM 的 OHCA 患者 DWI-ASPECTS 上弥散受限程度越广泛，6 个月时不良神经结局的可能性越大。
