Scholarlink

Background <p>Magnetic resonance imaging (MRI) is recommended by guidelines to evaluate the severity of brain ischemia after cardiac arrest for functional outcome prediction. However, standardized assessment criteria are lacking. We have developed a semi-quantitative Cardiac Arrest Brain Ischemia (CABI) score to assess the extension of brain ischemia on MRI.</p> Objectives <p>To evaluate the prognostic performance of a novel semi-quantitative CABI score in comparison to qualitative routine radiological MRI assessment after cardiac arrest.</p> Methods <p>A retrospective, multicenter observational study of adults (≥ 18 years-old) admitted to intensive care after cardiac arrest at four Swedish hospitals from 2014 to 2018.</p> <p> <?noindent??>Four radiologists, blinded to clinical information except patient age, assessed the MRI as per guideline recommendations and according to the CABI score. The CABI score evaluates extension of ischemia in 12 predefined territories (3 cortical and 2 deep grey nuclei territories bilaterally based on vascular supply; the cerebellum; and the brainstem) from 0–3 (0 = No acute ischemic lesion; 3 ≥ 50% of the territory). The CABI score ranges from 0–36. Poor functional outcome was defined as Cerebral Performance Category 3–5 assessed at 2–6 months post-arrest. Prognostic ability was evaluated with sensitivity and specificity and with the area under the receiver operating characteristics curve (AUC). Inter-rater reliability was calculated by Fleiss´ Kappa or intraclass correlation coefficient.</p> Results <p>Ninety (n = 90) patients examined with MRI at median 5 days (IQR: 3.7−6.3) were included Median age was 63.7 years (IQR: 58.3−70.5), 74.4% (n = 67) were men and 85.6% (n = 77) had a poor functional outcome. Among four blinded raters, routine qualitative assessment according to guidelines showed 84.6–100% specificity and 61–76.6% sensitivity for poor outcome. Inter-rater reliability for the qualitative assessment was moderate (Fleiss κ = 0.64, 95% CI: 0.53−0.75). The CABI score achieved an AUC of 0.87–0.92 (p&lt; 0.05 vs. routine assessment) and a sensitivity of 59.7−85.7% while maintaining high specificity (76.9–100%) at cut-off ≥ 8 points. The intraclass correlation coefficient (ICC) for the CABI score was 0.67 (95% CI: 0.58–0.75), reflecting moderate agreement among raters.</p> Conclusion <p>A semi-quantitative approach to MRI evaluations after cardiac arrest may increase the prognostic accuracy compared to non-standardized routine assessment.</p> Trial registration <p>SweCrit biobank, retrospectively registered at ClinicalTrials.gov no. NCT04974775 18th of June 2021.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The semi-quantitative cardiac arrest brain ischemia (CABI) score for magnetic resonance imaging predicts functional outcome after cardiac arrest

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年8月20日

查看全文
  • Isabelle Arctaedius,
  • Johan Wassélius,
  • Margareta Lang,
  • Mattias Drake,
  • Mikael Johnsson,
  • Hans Friberg,
  • Christoph Leithner,
  • Martin Kenda,
  • Anna Lybeck,
  • Marion Moseby-Knappe

摘要

Background

Magnetic resonance imaging (MRI) is recommended by guidelines to evaluate the severity of brain ischemia after cardiac arrest for functional outcome prediction. However, standardized assessment criteria are lacking. We have developed a semi-quantitative Cardiac Arrest Brain Ischemia (CABI) score to assess the extension of brain ischemia on MRI.

Objectives

To evaluate the prognostic performance of a novel semi-quantitative CABI score in comparison to qualitative routine radiological MRI assessment after cardiac arrest.

Methods

A retrospective, multicenter observational study of adults (≥ 18 years-old) admitted to intensive care after cardiac arrest at four Swedish hospitals from 2014 to 2018.

Four radiologists, blinded to clinical information except patient age, assessed the MRI as per guideline recommendations and according to the CABI score. The CABI score evaluates extension of ischemia in 12 predefined territories (3 cortical and 2 deep grey nuclei territories bilaterally based on vascular supply; the cerebellum; and the brainstem) from 0–3 (0 = No acute ischemic lesion; 3 ≥ 50% of the territory). The CABI score ranges from 0–36. Poor functional outcome was defined as Cerebral Performance Category 3–5 assessed at 2–6 months post-arrest. Prognostic ability was evaluated with sensitivity and specificity and with the area under the receiver operating characteristics curve (AUC). Inter-rater reliability was calculated by Fleiss´ Kappa or intraclass correlation coefficient.

Results

Ninety (n = 90) patients examined with MRI at median 5 days (IQR: 3.7−6.3) were included Median age was 63.7 years (IQR: 58.3−70.5), 74.4% (n = 67) were men and 85.6% (n = 77) had a poor functional outcome. Among four blinded raters, routine qualitative assessment according to guidelines showed 84.6–100% specificity and 61–76.6% sensitivity for poor outcome. Inter-rater reliability for the qualitative assessment was moderate (Fleiss κ = 0.64, 95% CI: 0.53−0.75). The CABI score achieved an AUC of 0.87–0.92 (p< 0.05 vs. routine assessment) and a sensitivity of 59.7−85.7% while maintaining high specificity (76.9–100%) at cut-off ≥ 8 points. The intraclass correlation coefficient (ICC) for the CABI score was 0.67 (95% CI: 0.58–0.75), reflecting moderate agreement among raters.

Conclusion

A semi-quantitative approach to MRI evaluations after cardiac arrest may increase the prognostic accuracy compared to non-standardized routine assessment.

Trial registration

SweCrit biobank, retrospectively registered at ClinicalTrials.gov no. NCT04974775 18th of June 2021.