Value of assessment of multivoxel proton chemical shift imaging to predict long term outcome in patients after out-of-hospital cardiac arrest: A preliminary prospective observational study

RESUSCITATION

卷:134

Article

Quintard, Herve^1,2  Velly, Lionel^3,4  Boussen, Salah^3,5  Chiosi, Xavier¹  Amoretti, Marie-Eve⁶  Cervantes, Elodie⁶  Ichai, Carole¹ 

[1] Univ Cote dAzur, CHU Nice, Hop Pasteur 2, Dept Anaesthesiol & Crit Care Med, Nice, France

[2] CNRS, UMR 7275, Sophia Antipolis, France

[3] Aix Marseille Univ, Univ Hosp La Timone, Dept Anaesthesiol & Crit Care Med, Marseille, France

[4] Aix Marseille Univ, INT, Marseille, France

[5] Aix Marseille Univ, Lab Biomecan Appl IFSTTAR, Marseille, France

[6] Univ Cate dAzur, CHU Nice, Hop Pasteur 2, Radiol Dept, Nice, France

关键词: Cardiac arrest;    Outcome;    Prognosis;    Magnetic resonance imaging;    Chemical shift imaging;    Magnetic resonance spectroscopic;    Hypoxic ischemic encephalopathy;    Diffusion weighted imaging;   

DOI  :  10.1016/j.resuscitation.2018.09.007

来源: Elsevier

【 摘 要 】

Background: Existing methods to predict recovery after out-of-hospital cardiac arrest (OHCA) lack of accuracy. The aim of this study was to determine whether quantitative proton chemical shift imaging (H-1-CSI) during the subacute stage of OHCA can predict neurological outcome of such patients. Methods: This monocentric prospective observational study was conducted in a Intensive Care Unit of a teaching hospital. Forty consecutive patients with OHCA were enrolled between January 1st 2011-December 31st 2013. Multivoxel H-1-CSI values were compared to structural magnetic resonance imaging (MRI) sequences (fluid-attenuated inversion recovery and diffusion-weighted imaging). Ratios of N-acetyl-aspartate (NAA) to creatine (Cr) and choline compounds were analyzed using region of interest in bilateral lenticular cores and thalami. The outcome evaluated was the Cerebral Performance Category (CPC) at 6 months, dichotomized as favorable (CPC 1-2) and unfavorable outcome (CPC 3-5). The performance was compared by area under the receiver operating characteristic (ROCAUC) curves analysis. Results: Twenty nine OHCA had an interpretable MRI. Eight patients (28%) had favorable outcome at 6 months. The worst NAA/Cr in lenticular cores was the best H-1-CSI marker, with 80% sensitivity (95% confidence interval (CI), 57-94) and a 100% specificity (95% CI, 63-100) with a positive predictive value of 100%. Prognostic accuracy, as quantified by the ROCAUC, was higher with the worst NAA/Cr in lenticular cores (ROCAUC 0.88; 95% CI, 0.70-0.97) than with the structural MRI sequences. Conclusion: In this preliminary study we found that multivoxel H-1-CSI in lenticular cores was highly predictive of unfavorable outcome at 6 months.

【 授权许可】

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