Assessment of Brain Magnetic Resonance and Spectroscopy Imaging Findings and Outcomes After Pediatric Cardiac Arrest.
Assessment of Brain Magnetic Resonance and Spectroscopy Imaging Findings and Outcomes After Pediatric Cardiac Arrest.
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DOI：
10.1001/jamanetworkopen.2023.20713
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发表时间：
2023-06-01
影响因子：
13.8
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本队列研究分析了磁共振成像显示的脑损伤和磁共振波谱显示的乳酸和n -乙酰天冬氨酸浓度与儿童心脏骤停后1年预后的关系。小儿心脏骤停后2周内用磁共振成像（MRI）和磁共振波谱（MRS）评估脑区域特征是否与1年预后相关？在这项多中心队列研究中，98名心脏骤停儿童接受了临床MRI或MRS检查，MRI损伤评分较高，感兴趣区域乳酸升高，n -乙酰天冬氨酸降低与1年的不良预后相关。这些发现表明，在儿童心脏骤停后的前2周使用MRI或MRS进行脑成像可能有助于结果评估。儿童心脏骤停后的发病率和死亡率主要是由于缺氧缺血性脑损伤。在心脏骤停后，在磁共振成像（MRI）和磁共振波谱（MRS）上看到的大脑特征可以识别损伤并有助于结果评估。分析小儿心脏骤停后1年预后与t2加权MRI和弥散加权成像显示的脑病变以及MRS显示的n-乙酰天冬氨酸（NAA）和乳酸浓度的关系。这项多中心队列研究于2017年5月16日至2020年8月19日期间在美国14家医院的儿科重症监护室进行。从院内或院外心脏骤停复苏并在停搏后14天内进行临床脑MRI或MRS检查的48小时至17岁的儿童被纳入研究。数据分析时间为2022年1月至2023年2月。主要转归是心脏骤停后1年的不良转归（死亡或生存，根据Vineland适应行为量表，第三版，评分<70）。由2名盲法儿科神经放射学家根据MRI脑病变的区域和严重程度（0 =无，1 =轻度，2 =中度，3 =重度）进行评分。MRI损伤评分是灰质和白质t2加权和弥散加权成像病变的总和（最高评分34）。定量测定基底神经节、丘脑、枕顶白质和灰质中的乳酸MRS和NAA浓度。进行逻辑回归以确定MRI和MRS特征与患者预后的关系。共纳入98例儿童，其中66例接受脑MRI检查（年龄中位数为1.0[0.0-3.0]岁，女孩28例[42.4%]，白人儿童46例[69.7%]），32例接受脑MRS检查（年龄中位数为1.0[0.0-9.5]岁，女孩13例[40.6%]，白人儿童21例[65.6%]）。MRI组23例（34.8%）患儿出现不良预后，MRS组12例（37.5%）患儿出现不良预后。结果不良儿童的MRI损伤评分（[IQR]中位评分，22[7-32]）高于结果良好儿童（[IQR]中位评分，1[0-8]）。在所有4个感兴趣的区域，乳酸升高和NAA降低与不良结果相关。在调整临床特征的多变量logistic回归中，MRI损伤评分升高（优势比为1.12；95% CI为1.04-1.20）与不良结果相关。在这项心脏骤停儿童的队列研究中，骤停后2周内MRI和MRS的脑特征与1年预后相关，表明这些成像模式在识别损伤和评估预后方面的效用。
This cohort study analyzes the association of brain lesions seen on magnetic resonance imaging and concentrations of lactate and N-acetylaspartate seen on magnetic resonance spectroscopy with 1-year outcomes after pediatric cardiac arrest. Are regional brain features assessed with magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) within 2 weeks of pediatric cardiac arrest associated with outcomes at 1 year? In this multicenter cohort study of 98 children with cardiac arrest who underwent clinical MRI or MRS, higher MRI Injury Score, increased lactate, and decreased N-acetylaspartate in regions of interest were associated with an unfavorable outcome at 1 year. These findings suggest that brain imaging using MRI or MRS during the first 2 weeks after pediatric cardiac arrest may aid in outcome assessment. Morbidity and mortality after pediatric cardiac arrest are chiefly due to hypoxic-ischemic brain injury. Brain features seen on magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) after arrest may identify injury and aid in outcome assessments. To analyze the association of brain lesions seen on T2-weighted MRI and diffusion-weighted imaging and N-acetylaspartate (NAA) and lactate concentrations seen on MRS with 1-year outcomes after pediatric cardiac arrest. This multicenter cohort study took place in pediatric intensive care units at 14 US hospitals between May 16, 2017, and August 19, 2020. Children aged 48 hours to 17 years who were resuscitated from in-hospital or out-of-hospital cardiac arrest and who had a clinical brain MRI or MRS performed within 14 days postarrest were included in the study. Data were analyzed from January 2022 to February 2023. Brain MRI or MRS. The primary outcome was an unfavorable outcome (either death or survival with a Vineland Adaptive Behavior Scales, Third Edition, score of <70) at 1 year after cardiac arrest. MRI brain lesions were scored according to region and severity (0 = none, 1 = mild, 2 = moderate, 3 = severe) by 2 blinded pediatric neuroradiologists. MRI Injury Score was a sum of T2-weighted and diffusion-weighted imaging lesions in gray and white matter (maximum score, 34). MRS lactate and NAA concentrations in the basal ganglia, thalamus, and occipital-parietal white and gray matter were quantified. Logistic regression was performed to determine the association of MRI and MRS features with patient outcomes. A total of 98 children, including 66 children who underwent brain MRI (median [IQR] age, 1.0 [0.0-3.0] years; 28 girls [42.4%]; 46 White children [69.7%]) and 32 children who underwent brain MRS (median [IQR] age, 1.0 [0.0-9.5] years; 13 girls [40.6%]; 21 White children [65.6%]) were included in the study. In the MRI group, 23 children (34.8%) had an unfavorable outcome, and in the MRS group, 12 children (37.5%) had an unfavorable outcome. MRI Injury Scores were higher among children with an unfavorable outcome (median [IQR] score, 22 [7-32]) than children with a favorable outcome (median [IQR] score, 1 [0-8]). Increased lactate and decreased NAA in all 4 regions of interest were associated with an unfavorable outcome. In a multivariable logistic regression adjusted for clinical characteristics, increased MRI Injury Score (odds ratio, 1.12; 95% CI, 1.04-1.20) was associated with an unfavorable outcome. In this cohort study of children with cardiac arrest, brain features seen on MRI and MRS performed within 2 weeks after arrest were associated with 1-year outcomes, suggesting the utility of these imaging modalities to identify injury and assess outcomes.