Prognostic value of brain diffusion-weighted imaging after cardiac arrest.
Prognostic value of brain diffusion-weighted imaging after cardiac arrest.
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DOI：
10.1002/ana.21632
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发表时间：
2009-04
影响因子：
11.2
通讯作者：
Moseley, Michael
中科院分区：
文献类型：
--
作者：
Wijman, Christine A. C.;Mlynash, Michael;Caulfield, Anna Finley;Hsia, Amie W.;Eyngorn, Irina;Bammer, Roland;Fischbein, Nancy;Albers, Gregory W.;Moseley, Michael
心脏骤停后昏迷幸存者的预后预测具有挑战性。我们在第一周评估了脑弥散加权MRI （DWI）的可行性和预后效用。前瞻性纳入连续昏迷的心脏骤停后患者。符合预定义的特定预后标准的患者的MRI数据用于确定区分ADC阈值。第1组：6个月时死亡，72小时时运动反应或瞳孔反射或双侧皮质反应缺失，或1个月时营养不良。2A组：6个月时格拉斯哥结局量表（GOS）评分为4或5分。2B组：6个月时GOS 3例。以50 × 10−6 mm2/sec的间隔计算低于不同表观扩散系数（ADC）阈值的体素百分比。总体而言，86%的患者接受了磁共振成像。51名患者的62个脑部核磁共振成像被纳入分析。40例患者符合特定的预后标准。ADC值低于650-700 × 10 - 6 mm2/sec的脑容量百分比在1组和2A、2B联合组之间差异最大（p<0.001），而400-450 × 10 - 6 mm2/sec阈值在2A和2B组之间差异最大（p=0.003）。使用DWI进行预测的理想时间窗口是在逮捕后49至108小时之间。将该时间窗的MRI与72小时神经学检查进行比较，MRI预测不良预后的敏感性提高38%，同时保持100%的特异性（p=0.021）。定量DWI在昏迷的心脏骤停幸存者中作为预后辅助手段具有很大的希望。
Outcome prediction is challenging in comatose post-cardiac arrest survivors. We assessed the feasibility and prognostic utility of brain diffusion-weighted MRI (DWI) during the first week. Consecutive comatose post-cardiac arrest patients were prospectively enrolled. MRI data of patients who met predefined specific prognostic criteria were used to determine distinguishing ADC thresholds. Group 1: death at 6 months and absent motor response or absent pupillary reflexes or bilateral absent cortical responses at 72 hours, or vegetative at 1 month. Group 2A: Glasgow outcome scale (GOS) score of 4 or 5 at 6 months. Group 2B: GOS of 3 at 6 months. The percentage of voxels below different apparent diffusion coefficient (ADC) thresholds was calculated at 50 × 10−6 mm2/sec intervals. Overall, 86% of patients underwent MR imaging. Fifty-one patients with 62 brain MRIs were included in the analyses. Forty patients met the specific prognostic criteria. The percentage of brain volume with an ADC value below 650–700 × 10−6 mm2/sec best differentiated between group 1 and groups 2A and 2B combined (p<0.001), while the 400–450 × 10−6 mm2/sec threshold best differentiated between groups 2A and 2B (p=0.003). The ideal time window for prognostication using DWI was between 49 to 108 hours after the arrest. When comparing MRI in this time window with the 72 hour neurological examination MRI improved the sensitivity for predicting poor outcome by 38% while maintaining 100% specificity (p=0.021). Quantitative DWI in comatose post-cardiac arrest survivors holds great promise as a prognostic adjunct.
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影响因子：
9.9
作者：
Chalela, JA;Wolf, RL;Kasner, SE
通讯作者：
Kasner, SE
影响因子：
1.3
作者：
Hald, JK;Brunberg, JA;Wootton-Gorges, SL
通讯作者：
Wootton-Gorges, SL
影响因子：
6.5
作者：
Krep, H;Böttiger, BW;Hossmann, KA
通讯作者：
Hossmann, KA
影响因子：
37.8
作者：
LOWN, B
通讯作者：
LOWN, B
影响因子：
158.5
作者：
Bernard, SA;Gray, TW;Smith, K
通讯作者：
Smith, K