Beutler Bryce D, Antwi-Amoabeng Daniel, Weinert Dane, Shah Ishan, Ulanja Mark B, Moody Alastair E, Lei Xiaomeng, Lerner Alexander, Shiroishi Mark S, Assadsangabi Reza
Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States.
Department of Internal Medicine, Christus Ochsner St. Patrick Hospital, Lake Charles, LA 70601, United States.
World J Radiol. 2025 Aug 28;17(8):111065. doi: 10.4329/wjr.v17.i8.111065.
Anoxic brain injury is a potentially lethal condition characterized by cerebral hypoperfusion and irreversible neuronal injury. Arterial spin-labeling (ASL) perfusion and diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) have been proposed as tools to detect cerebral ischemic changes and may aid in the assessment of anoxic injury.
To explore the relationship between regional ASL perfusion patterns and clinical outcomes following cardiac arrest.
We performed a retrospective review to identify patients with clinical suspicion of anoxic brain injury who underwent MRI within 15 days of cardiac arrest. Receiver operator characteristic (ROC) analysis and univariate logistic regression were used to evaluate associations between ASL perfusion scores, DWI signal intensity, and the following clinical features: (1) Myoclonus status epilepticus (MSE) within 24 hours; (2) Absent extensor or motor reflexes (EMR) at day 3 post-arrest; and (3) Absent brainstem reflexes (BSR) within 15 days.
Twenty-eight patients met inclusion criteria. Increased ASL signal in the left occipital lobe was significantly associated with MSE ( = 0.038), while a trend was observed between right frontal ASL signal and EMR ( = 0.078). ROC analysis showed that ASL scores ≥ 7 were associated with higher odds of absent BSR (OR 2.14, = 0.53), though this did not reach statistical significance. DWI signal intensity did not show significant associations with clinical outcomes. The overall discriminatory performance of ASL for predicting outcomes was limited (AUC ≈ 0.52).
This exploratory study suggests that regional ASL hyperperfusion, particularly in the left occipital and right frontal lobes, may be associated with adverse clinical signs following cardiac arrest. However, most findings did not reach statistical significance, and the study was underpowered to detect small-to-moderate effects. These preliminary results should be interpreted with caution and considered hypothesis-generating. Larger, prospective studies are warranted to clarify the prognostic value of ASL perfusion imaging in anoxic brain injury.
缺氧性脑损伤是一种潜在的致命疾病，其特征为脑灌注不足和不可逆的神经元损伤。动脉自旋标记（ASL）灌注和扩散加权成像（DWI）磁共振成像（MRI）已被提议作为检测脑缺血变化的工具，并可能有助于评估缺氧性损伤。
探讨心脏骤停后局部ASL灌注模式与临床结局之间的关系。
我们进行了一项回顾性研究，以确定在心脏骤停后15天内接受MRI检查且临床怀疑有缺氧性脑损伤的患者。采用受试者操作特征（ROC）分析和单因素逻辑回归来评估ASL灌注评分、DWI信号强度与以下临床特征之间的关联：（1）24小时内的肌阵挛性癫痫持续状态（MSE）；（2）心脏骤停后第3天无伸肌或运动反射（EMR）；（3）15天内无脑干反射（BSR）。
28例患者符合纳入标准。左侧枕叶ASL信号增强与MSE显著相关（P = 0.038），而右侧额叶ASL信号与EMR之间观察到一种趋势（P = 0.078）。ROC分析显示，ASL评分≥7与无BSR的较高几率相关（OR 2.14，P = 0.53），尽管这未达到统计学意义。DWI信号强度与临床结局未显示出显著关联。ASL预测结局的总体鉴别性能有限（AUC≈0.52）。
这项探索性研究表明，局部ASL灌注过度，尤其是在左侧枕叶和右侧额叶，可能与心脏骤停后的不良临床体征相关。然而，大多数结果未达到统计学意义，且该研究检测小至中度效应的能力不足。这些初步结果应谨慎解释，并视为产生假设。需要开展更大规模的前瞻性研究来阐明ASL灌注成像在缺氧性脑损伤中的预后价值。
