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목표 체온 조절 치료를 받은 심정지 환자에서의 예후 평가 도구로서 뇌 MRI T2 weighted image에서의 회색질과 백색질 신호 강도 비의 유용성: 선행연구

Utility of white matter to gray matter signal intensity ratio in comatose patients treated by targeted temperature management after cardiac arrest: a preliminary study

대한응급의학회지 2019년 30권 5호 p.437 ~ 446
금경탁 ( Keum Kyoung-Tak ) - 성균관대학교 의과대학 삼성창원병원 응급의학과

김용환 ( Kim Yong-Hwan ) - 성균관대학교 의과대학 삼성창원병원 응급의학과
황성연 ( Hwang Seong-Youn ) - 성균관대학교 의과대학 삼성창원병원 응급의학과
이준호 ( Lee Jun-Ho ) - 성균관대학교 의과대학 삼성창원병원 응급의학과
이동우 ( Lee Dong-Woo ) - 성균관대학교 의과대학 삼성창원병원 응급의학과
송윤규 ( Song Yun-Gyu ) - 성균관대학교 의과대학 삼성창원병원 영상의학과
이정화 ( Lee Jung-Hwa ) - 이화여자대학교 목동병원 신경과학교실 응급중환자진료과
이경렬 ( Lee Kyoung-Yul ) - 경남대학교 체육교육학과

Abstract


Objective: This study examined the efficacy of the white matter (WM) to gray matter (GM) signal intensity ratio (SIR) in predicting the clinical prognosis of cardiac arrest patients.

Method: Thirty-one patients who were resuscitated from cardiac arrest and underwent brain magnetic resonance imaging (MRI) were investigated retrospectively. Thirty one subjects with normal brain MRI findings served as the controls. The signal intensities (SI) were measured on T2-weighted image (T2WI). The circular regions of measurement (2-10 mm2) were placed over the regions of interest, and the average signals in GM and WM were recorded in the caudate nucleus (CN), putamen, anterior limb of the internal capsule, corpus callosum (CC), and in the cortex and WM of the frontal lobe. Cerebral performance category (CPC) 1-2 were classified as a good prognosis, and CPC 3-5 were classified as a poor prognosis.

Results: Most combinations of the SIR of WM to GM and most SIs of GM, except the frontal cortex, were significantly different between the two groups. On the other hand, the SI of WM was insignificant between both groups. In receiver operating characteristic (ROC) curve analysis, the SIR of the CC to CN had an area under the ROC curve (AUROC) of 1.00 for a cut-off value of 1.59 (sensitivity, 100%; specificity, 100%), the SIR of the CC to putamen had also an AUROC of 1.00 for a cut-off value of 1.43 (sensitivity, 100%; specificity, 100%).

Conclusion: The SIR of WM to GM measured on a T2WI is related to the neurological outcome after a cardiac arrest.

키워드

Cardiac arrest; Magnetic resonance imaging; Prognosis; Signal intensity
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