Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients
Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients
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DOI：
10.1001/jamaneurol.2020.3263
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发表时间：
2020-09-08
期刊：
影响因子：
29
通讯作者：
Kimberly, W. Taylor
中科院分区：
文献类型：
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作者：
Sheth, Kevin N.;Mazurek, Mercy H.;Kimberly, W. Taylor
问题 能否在重症监护室的床边使用新型便携式低场磁共振成像 (MRI) 设备评估危重患者的脑损伤？结果 在这项使用便携式床边 MRI 设备对 50 名患者进行成像的队列研究中，包括缺血性中风、出血性中风、蛛网膜下腔出血、创伤性脑损伤、脑肿瘤和 COVID-19 以及精神状态改变的患者，在 30 名未患 COVID-19 的患者中，有 29 名检测到异常神经影像学结果（97%）； 20 名 COVID-19 患者中有 8 名 (40%) 表现出异常。没有不良事件或并发症。意义 这项研究展示了低场便携式 MRI 在重症监护病房床边获得神经影像的能力。这项队列研究描述了在床边使用便携式低场磁共振成像设备而不是传统成像套件对重症监护病房的重症患者脑损伤进行评估的结果。神经影像的重要性神经影像是脑损伤临床评估的关键步骤。传统的磁共振成像 (MRI) 系统在高强度磁场 (1.5-3 T) 下运行，需要严格的访问控制环境。及时获得神经影像的机会有限仍然是重症监护环境中有效监测神经损伤发生和进展的关键结构性障碍。低场 MRI 技术的最新进展允许在放射科之外以及床边存在铁磁材料的情况下采集具有临床意义的成像。目的 使用床边便携式低场 MRI 设备对重症监护病房的危重患者进行脑损伤评估。设计、设置和参与者这是一项前瞻性、单中心队列研究，研究对象为 2019 年 10 月 30 日至 2020 年 5 月 20 日期间入住康涅狄格州纽黑文市耶鲁纽黑文医院神经科学或 2019 年冠状病毒病 (COVID-19) 重症监护病房的 50 名患者。如果患者出现神经损伤或改变、没有常规 MRI 禁忌证且身体形态不超过扫描仪的标准，则符合资格。 30 厘米垂直开口。 COVID-19 的诊断是根据严重急性呼吸综合征冠状病毒 2 聚合酶链反应鼻咽拭子结果呈阳性确定的。在重症监护室中暴露便携式 MRI。主要成果和措施 收集并分析人口统计、临床、放射学和治疗数据。描述了脑成像结果。结果 对 50 名患者进行了即时 MRI 检查（16 名女性 [32%]；平均 [SD] 年龄，59 [12] 岁 [范围，20-89 岁]）。患者患有缺血性中风 (n = 9)、出血性中风 (n = 12)、蛛网膜下腔出血 (n = 2)、创伤性脑损伤 (n = 3)、脑肿瘤 (n = 4) 和精神状态改变的 COVID-19 (n = 20)。检查是在入住重症监护病房后平均 5 天（范围为 0-37）天进行的。分别为 37、48、45 和 32 名患者获得了诊断级 T1 加权、T2 加权、T2 流体衰减反转恢复和扩散加权成像序列。在 30 名未感染 COVID-19 的患者中，有 29 名（97%）检测到了神经影像学结果，在 20 名患有 COVID-19 的患者中，有 8 名（40%）表现出异常。在重症监护病房部署便携式 MRI 或扫描期间，没有出现任何不良事件或并发症。结论和相关性 这个单中心系列重症监护室的危重患者证明了低场便携式 MRI 的可行性。这些发现证明了便携式 MRI 在复杂的临床护理环境中获取神经影像的潜在作用。
Question Can brain injury in patients who are critically ill be assessed using a novel portable, low-field magnetic resonance imaging (MRI) device at the bedside in an intensive care setting? Findings In this cohort study of a series of 50 patients imaged with a portable, bedside MRI device, including patients with ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, traumatic brain injury, brain tumor, and COVID-19 and altered mental status, abnormal neuroimaging findings were detected in 29 of 30 patients without COVID-19 (97%); 8 of 20 patients with COVID-19 (40%) demonstrated abnormalities. There were no adverse events or complications. Meaning This study demonstrates the capability of low-field, portable MRI to obtain neuroimaging at the bedside in intensive care settings.This cohort study describes the outcomes of assessments of brain injury in patients with critical illness in intensive care units using a portable low-field magnetic resonance image device at the bedside, rather than a conventional imaging suite.Importance Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional magnetic resonance imaging (MRI) systems operate at high-strength magnetic fields (1.5-3 T) that require strict, access-controlled environments. Limited access to timely neuroimaging remains a key structural barrier to effectively monitor the occurrence and progression of neurological injury in intensive care settings. Recent advances in low-field MRI technology have allowed for the acquisition of clinically meaningful imaging outside of radiology suites and in the presence of ferromagnetic materials at the bedside. Objective To perform an assessment of brain injury in critically ill patients in intensive care unit settings, using a portable, low-field MRI device at the bedside. Design, Setting, and Participants This was a prospective, single-center cohort study of 50 patients admitted to the neuroscience or coronavirus disease 2019 (COVID-19) intensive care units at Yale New Haven Hospital in New Haven, Connecticut, from October 30, 2019, to May 20, 2020. Patients were eligible if they presented with neurological injury or alteration, no contraindications for conventional MRI, and a body habitus not exceeding the scanner's 30-cm vertical opening. Diagnosis of COVID-19 was determined by positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction nasopharyngeal swab result. Exposures Portable MRI in an intensive care unit room. Main Outcomes and Measures Demographic, clinical, radiological, and treatment data were collected and analyzed. Brain imaging findings are described. Results Point-of-care MRI examinations were performed on 50 patients (16 women [32%]; mean [SD] age, 59 [12] years [range, 20-89 years]). Patients presented with ischemic stroke (n = 9), hemorrhagic stroke (n = 12), subarachnoid hemorrhage (n = 2), traumatic brain injury (n = 3), brain tumor (n = 4), and COVID-19 with altered mental status (n = 20). Examinations were acquired at a median of 5 (range, 0-37) days after intensive care unit admission. Diagnostic-grade T1-weighted, T2-weighted, T2 fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences were obtained for 37, 48, 45, and 32 patients, respectively. Neuroimaging findings were detected in 29 of 30 patients who did not have COVID-19 (97%), and 8 of 20 patients with COVID-19 (40%) demonstrated abnormalities. There were no adverse events or complications during deployment of the portable MRI or scanning in an intensive care unit room. Conclusions and Relevance This single-center series of patients with critical illness in an intensive care setting demonstrated the feasibility of low-field, portable MRI. These findings demonstrate the potential role of portable MRI to obtain neuroimaging in complex clinical care settings.