Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
J Cereb Blood Flow Metab. 2024 Jan;44(1):50-65. doi: 10.1177/0271678X231197392. Epub 2023 Sep 20.
Early prediction of the recovery of consciousness in comatose cardiac arrest patients remains challenging. We prospectively studied task-relevant fMRI responses in 19 comatose cardiac arrest patients and five healthy controls to assess the fMRI's utility for neuroprognostication. Tasks involved instrumental music listening, forward and backward language listening, and motor imagery. Task-specific reference images were created from group-level fMRI responses from the healthy controls. Dice scores measured the overlap of individual subject-level fMRI responses with the reference images. Task-relevant responsiveness index (Rindex) was calculated as the maximum Dice score across the four tasks. Correlation analyses showed that increased Dice scores were significantly associated with arousal recovery () and emergence from the minimally conscious state (EMCS) by one year () for all tasks except motor imagery. Greater Rindex was significantly correlated with improved arousal recovery (P = 0.002) and consciousness (P = 0.001). For patients who survived to discharge (), the Rindex's sensitivity was 75% for predicting EMCS (n = 4). Task-based fMRI holds promise for detecting covert consciousness in comatose cardiac arrest patients, but further studies are needed to confirm these findings. Caution is necessary when interpreting the absence of task-relevant fMRI responses as a surrogate for inevitable poor neurological prognosis.
昏迷心脏骤停患者意识恢复的早期预测仍然具有挑战性。我们前瞻性地研究了 19 例昏迷心脏骤停患者和 5 例健康对照者的任务相关 fMRI 反应，以评估 fMRI 在神经预后中的作用。任务包括器乐聆听、正向和反向语言聆听以及运动想象。任务特定的参考图像是从健康对照组的群体水平 fMRI 反应中创建的。Dice 评分衡量个体 subject-level fMRI 反应与参考图像的重叠程度。任务相关响应性指数（Rindex）是通过四个任务计算的最大 Dice 评分。相关分析表明，除运动想象外，所有任务的 Dice 评分增加与觉醒恢复（）和最小意识状态（EMCS）的出现（）呈正相关（）。较大的 Rindex 与觉醒恢复（P=0.002）和意识（P=0.001）的改善显著相关。对于存活至出院的患者（），Rindex 的敏感性为 75%，可预测 EMCS（n=4）。基于任务的 fMRI 有望检测昏迷心脏骤停患者的隐匿性意识，但需要进一步的研究来证实这些发现。当将任务相关 fMRI 反应的缺失解释为不可避免的不良神经预后的替代指标时，需要谨慎。
