ICM:头部计算机断层扫描的标准化自动评估可可靠预测心脏骤停后的不良功能预后：一项前瞻性多中心研究

Abstract

Purpose: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest.

目的：应用标准化和自动化的头部计算机断层扫描（CT）评估方法，用于院外心脏骤停后的神经预后。

Methods: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey-white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4-6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated.

方法：在院外心脏骤停后目标性低温治疗与目标性常温治疗（TTM2）试验中进行的前瞻性、国际性、多中心、观察性研究。常规CT扫描来自成人无意识患者，在心脏骤停后超过48小时且不超过7天进行评估。由七位国际评审员使用预先发布的协议，对临床信息一无所知的情况下，对CT进行定性和定量评估。从基底节水平手动放置的四个（GWR-4）和八个（GWR-8）感兴趣区域计算灰白质比率（GWR）。此外，还使用自动化的基于图谱的方法获取GWR。计算定性评估和预先定义的GWR截止值<1.10对预测不良功能结果（改良Rankin量表4-6）的预测准确性。

Results: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59-76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90-100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77-0.91) did not significantly differ from manually obtained GWR.

结果：包括140名无意识患者；中位年龄为68岁（四分位间距[IQR] 59-76），76%为男性，75%有不良结果。标准化定性评估和所有GWR模型以100%的特异性（95%置信区间[CI] 90-100）预测了不良结果。定性评估的敏感性中位数为37%，GWR-8为39%，GWR-4为30%，自动化GWR为41%。在预测准确性、内部和评审员间一致性方面，GWR-8优于GWR-4。自动化GWR的整体预测准确性（曲线下面积[AUC] 0.84，95% CI 0.77-0.91）与手动获取的GWR没有显著差异。

Conclusion: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.

结论：CT的标准化定性和定量评估是可靠和可行的方法，用于预测心脏骤停后的不良功能结果。自动化GWR有潜力使CT量化用于神经预后对所有治疗心脏骤停患者的中心都是可访问的。