Gong Ae Kyung, Oh Sang Hoon, Jang Jinhee, Park Kyu Nam, Kim Han Joon, Lee Ji Young, Youn Chun Song, Lim Jee Yong, Kim Hyo Joon, Bang Hyo Jin
Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Diagnostics (Basel). 2024 Aug 6;14(16):1701. doi: 10.3390/diagnostics14161701.
Brain swelling after cardiac arrest may affect brain ventricular volume. This study aimed to investigate the prognostic implications of ventricular volume on early thin-slice brain computed tomography (CT) after cardiac arrest. We measured the gray-to-white matter ratio (GWR) and the characteristics and volumes of the lateral, third, and fourth ventricles. The primary outcome was a poor 6-month neurological outcome. Of the 166 patients, 115 had a poor outcome. The fourth ventricle was significantly smaller in the poor outcome group (0.58 cm [95% CI, 0.43-0.80]) than in the good outcome group (0.74 cm [95% CI, 0.68-0.99], < 0.001). Ventricular characteristics and other ventricular volumes did not differ between outcome groups. The area under the curve for the fourth ventricular volume was 0.68, comparable to 0.69 for GWR. Lower GWR (<1.09) and lower fourth ventricular volume (<0.41 cm) predicted poor outcomes with 100% specificity and sensitivities of 8.7% (95% CI, 4.2-15.4) and 20.9% (95% CI, 13.9-29.4), respectively. Combining these measures improved the sensitivity to 25.2% (95% CI, 17.6-34.2). After adjusting for covariates, the fourth ventricular volume was independently associated with neurologic outcome. A marked decrease in fourth ventricular volume, with concomitant hypoattenuation on CT scans, more accurately predicted outcomes.
心脏骤停后脑水肿可能会影响脑室容积。本研究旨在探讨心脏骤停后早期薄层脑计算机断层扫描（CT）中脑室容积的预后意义。我们测量了灰质与白质比率（GWR）以及侧脑室、第三脑室和第四脑室的特征与容积。主要结局是6个月时神经功能预后不良。在166例患者中，115例预后不良。预后不良组的第四脑室明显小于预后良好组（0.58 cm [95%CI，0.43 - 0.80]）（预后良好组为0.74 cm [95%CI，0.68 - 0.99]，P < 0.001）。结局组之间脑室特征和其他脑室容积无差异。第四脑室容积的曲线下面积为0.68，与GWR的0.69相当。较低的GWR（<1.09）和较低的第四脑室容积（<0.41 cm）预测不良结局的特异性为100%，敏感性分别为8.7%（95%CI，4.2 - 15.4）和20.9%（95%CI，13.9 - 29.4）。联合这些指标可将敏感性提高至25.2%（95%CI，17.6 - 34.2）。在对协变量进行校正后，第四脑室容积与神经功能结局独立相关。第四脑室容积显著减小，同时CT扫描出现低密度影，能更准确地预测结局。
