The association between a quantitative computed tomography (CT) measurement of cerebral edema and outcomes in post-cardiac arrest-A validation study

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卷:85

Article

Cristia, Cristal¹  Ho, Mai-Lan²  Levy, Sean³  Andersen, Lars W.^1,4  Perman, Sarah M.⁵  Giberson, Tyler¹  Salciccioli, Justin D.¹  Saindon, Brian Z.¹  Cocchi, Michael N.^1,6  Donnino, Michael W.^1,7 

[1] Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA 02215 USA

[2] Beth Israel Deaconess Med Ctr, Dept Radiol, Boston, MA 02215 USA

[3] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[4] Aarhus Univ Hosp, Dept Anesthesiol, DK-8000 Aarhus, Denmark

[5] Univ Colorado, Sch Med, Dept Emergency Med, Boulder, CO 80309 USA

[6] Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care, Boston, MA 02215 USA

[7] Beth Israel Deaconess Med Ctr, Dept Med, Div Crit Care, Boston, MA 02215 USA

关键词: Cardiac arrest;    Post-cardiac arrest;    CT;    Computed tomography;    Cerebral edema;    Prognostication;   

DOI  :  10.1016/j.resuscitation.2014.05.022

来源: Elsevier

【 摘 要 】

Aim: Previous studies have examined the association between quantitative head computed tomography (CT) measures of cerebral edema and patient outcomes reporting that a calculated gray matter to white matter attenuation ratio (GWR) of < 1.2 indicates a near 100% non-survivable injury post-cardiac arrest. The objective of the current study was to validate whether a GWR < 1.2 reliably indicates poor survival post-cardiac arrest. We also sought to determine the inter-rater variability among reviewers, and examine the utility of a novel GWR measurement to facilitate easier practical use. Methods: We performed a retrospective analysis of post-cardiac arrest patients admitted to a single center from 2008 to 2012. Inclusion criteria were age >= 18 years, non-traumatic arrest, and available CT imaging within 24 h after ROSC. Three independent physician reviewers from different specialties measured CT attenuation of pre-specified gray and white matter areas for GWR calculations. Results: Out of 171 consecutive patients, 90 met the study inclusion criteria. Thirteen patients were excluded for technical reasons and/or significant additional pathology, leaving 77 head CT scans for evaluation. Median age was 66 years and 64% were male. In-hospital mortality was 65% and 70% of patients received therapeutic hypothermia. For the validation measurement, the intra-class correlation coefficient was 0.70. In our dataset, a GWR below 1.2 did not accurately predict mortality or poor neurological outcome (sensitivity 0.56-0.62 and specificity 0.63-0.81). A score below 1.1 predicted a near 100% mortality but was not a sensitive metric (sensitivity 0.14-0.20 and specificity 0.96-1.00). Similar results were found for the exploratory model. Conclusion: A GWR < 1.2 on CT imaging within 24 h after cardiac arrest was moderately specific for poor neurologic outcome and mortality. Based on our data, a threshold GWR < 1.1 may be a safer cut-off to identify patients with low chance of survival and good neurological outcome. Intra-class correlation among reviewers was moderately good. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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