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Measuring global impairment of cerebral perfusion using dynamic susceptibility contrast perfusion-weighted imaging in out-of-hospital cardiac arrest survivors: A prospective preliminary study - 30/12/20

Doi : 10.1016/j.neurad.2020.12.001 
Changshin Kang a, b, 1, In Ho Lee c, 1, Jung Soo Park a, b, , Yeonho You a, Wonjoon Jeong a, Hong Joon Ahn a, b, Jin Hong Min b
a Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea 
b Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea 
c Department of Radiology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea 

Corresponding author at: Department of Emergency Medicine, College of Medicine, Chungnam National University, 282, Mokdong-ro, Jung-gu, Daejeon, Republic of Korea.Department of Emergency MedicineCollege of MedicineChungnam National University282, Mokdong-ro, Jung-guDaejeonRepublic of Korea
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 30 December 2020

Graphical abstract




Le texte complet de cet article est disponible en PDF.

Highlights

The usefulness of measuring cerebral perfusion by using DSC-PWI has not been assessed in out-of-hospital cardiac arrest survivors.
Impaired cerebral perfusion measured by DSC-PWI is associated with outcomes in out-of-hospital cardiac arrest survivors.
Hyperaemia and delayed cerebral perfusion were generally observed in OHCA patients regardless of outcomes.
Increases or prolongation of cerebral perfusion parameters were greater in the poor outcome groups.
Arterial input function could be more useful to predict prognosis in cardiac arrest survival compared with normalisation method.

Le texte complet de cet article est disponible en PDF.

Abstract

Background and purpose

This study aimed to assess the global impairment and prognostic performance of cerebral perfusions (CP) measured by dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) in out-of-hospital cardiac arrest (OHCA) patients after sustained restoration of spontaneous circulation (ROSC).

Materials and methods

This is a single-centre, prospective observational study. OHCA patients performed DSC-PWI within 8 h after ROSC were enrolled. We quantified the CP parameters, such as cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP), and time to maximum of the residue function (Tmax) either by normalization or arterial input function (AIF). The primary and secondary outcomes were survival to discharge and comparison of prognostic performance between CP parameters and serum neuron-specific enolase (NSE) using area under the receiver operating characteristic (AUROC) and sensitivity values.

Results

Thirty-one patients were included in this study. CBV and TTP quantified by normalization, and MTT and Tmax quantified by AIF showed significantly higher CP values in the non-survival group (p = 0.02, 0.03, 0.02, and <0.01, respectively). Their AUROCs and 100% specific sensitivities were 0.74/25.0%, 0.60/33.3%, 0.75/56.3%, and 0.79/43.8%, respectively. MTT quantified by AIF showed sensitivity in predicting mortality at an early stage of PCA care, comparable with NSE.

Conclusion

Hyperaemia and delayed CP were generally observed in OHCA patients regardless of outcomes. MTT and Tmax quantified by AIF have prognostic performance in predicting mortality, comparable with NSE. Further prospective multicentre studies are required to confirm our results.

Le texte complet de cet article est disponible en PDF.

Abbreviations : AIF, AUROC, CA, CBF, CBV, DSC-PWI, HIBI, ICP, IQR, LC, MAP, MRI, MTT, OHCA, PCA, rCBF, rCBV, ROC, ROI, ROSC, Tmax, TTP, WLST

Keywords : Out-of-hospital cardiac arrest, Cerebrovascular circulation, Prognosis, Brain death, Magnetic resonance imaging, Perfusion-weighted MRI


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