Lang Margareta, Kenda Martin, Scheel Michael, Martola Juha, Wheeler Matthew, Owen Stephanie, Johnsson Mikael, Annborn Martin, Dankiewicz Josef, Deye Nicolas, Düring Joachim, Halliday Thomas, Jakobsen Janus Christian, Lascarrou Jean-Baptiste, Levin Helena, Lilja Gisela, Lybeck Anna, McGuigan Peter J, Rylander Christian, Sem Victoria, Thomas Matthew, Ullén Susann, Undén Johan, Wise Matt P, Cronberg Tobias, Wassélius Johan, Nielsen Niklas, Leithner Christoph, Moseby-Knappe Marion
Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden.
Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Charitéplats 1, 10117 Berlin, Germany.
Resuscitation. 2025 Sep;214:110675. doi: 10.1016/j.resuscitation.2025.110675. Epub 2025 Jun 9.
Qualitative assessment of hypoxic ischaemic encephalopathy on computed tomography (CT) after cardiac arrest is limited by interrater agreement. We explored how qualitative assessment can be improved.
In-depth analysis of radiological items evaluated in a prospective sub-study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial examining unconscious patients with CT > 48 h ≤ 7 days. Prognostic performance to diagnose poor outcome (modified Rankin Scale 4-6 at six months) and interrater agreement were evaluated for: "loss of grey-white matter distinction" and "sulcal effacement" at different anatomical levels, "the Pseudo Subarachnoid Haemorrhage Sign", "the White Cerebellum Sign", and "the Reversal Sign".
We included 140 patients examined with CT at median 84 h (IQR 66-109) post-arrest. Median age was 68 years (IQR 59-76), 106 (76%) were male and 105 (75%) had a poor functional outcome. "Loss of grey-white matter distinction" predicted poor functional outcome with 100% specificity and 45-50% sensitivity. The specificity for "sulcal effacement" was 93-99% and the sensitivity 29-49%. "The Pseudo Subarachnoid Haemorrhage Sign", "the Reversal Sign", and the "White Cerebellum Sign" predicted poor functional outcome with 99-100% specificity and 8-11% sensitivity. The highest interrater agreement was "moderate" (κ = 0.74) for the loss of grey-white matter distinction at high convexity level.
Extensive and bilateral loss of grey-white matter distinction on CT is associated with poor functional outcome after cardiac arrest and yielded the highest interrater agreement. Signs of sulcal effacement were less reliable and should thus be used with caution in neuroprognostication. The TTM2 CT substudy is registered at clinicaltrials.gov (NCT03913065).
心脏骤停后计算机断层扫描（CT）对缺氧缺血性脑病的定性评估受评分者间一致性的限制。我们探讨了如何改进定性评估。
对院外心脏骤停后目标体温管理2（TTM2）试验中一项前瞻性子研究中评估的放射学项目进行深入分析，该试验研究了心脏骤停后48小时>CT≤7天的昏迷患者。对不同解剖水平的“灰白质分界消失”和“脑沟变平”、“假性蛛网膜下腔出血征”、“小脑白质征”以及“反转征”，评估诊断不良预后（6个月时改良Rankin量表评分为4 - 6分）的预后性能和评分者间一致性。
我们纳入了140例患者，在心脏骤停后中位84小时（四分位间距66 - 109小时）进行了CT检查。中位年龄为68岁（四分位间距59 - 76岁），106例（76%）为男性，105例（75%）功能预后不良。“灰白质分界消失”预测功能预后不良的特异性为100%，敏感性为45 - 50%。“脑沟变平”的特异性为93 - 99%，敏感性为29 - 49%。“假性蛛网膜下腔出血征”、“反转征”和“小脑白质征”预测功能预后不良的特异性为99 - 100%，敏感性为8 - 11%。评分者间一致性最高为“中等”（κ = 0.74），用于评估高凸面水平的灰白质分界消失情况。
CT上广泛且双侧的灰白质分界消失与心脏骤停后的不良功能预后相关，并且评分者间一致性最高。脑沟变平的体征可靠性较低，因此在神经预后评估中应谨慎使用。TTM2 CT子研究已在clinicaltrials.gov注册（NCT03913065）。
