방사선의학 웹진

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Abstract
Background: Accurate prediction of survival outcomes after hanging is a crucial and challenging issue in comatose survivors. In this preclinical study, we evaluated the potential utility of using brain glucose metabolism as measured by fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for survival prediction in a rat model of hanging-induced hypoxic brain injury (HBI).

Methods: HBI was induced by mechanical hanging using Sprague Dawley rats. 18F-FDG brain PET images were acquired in 26 HBI rats three hours post-injury (3 h post-injury) and 4 controls. During the 1 month follow-up period, HBI rats were further classified as survivors (n = 15) and nonsurvivors (n = 11). Between-group regional (standardized uptake values normalized to the reference whole brain = SUVRWB, cerebellum = SUVRCB, and pons = SUVRpons) and voxel-based analyses were performed. The prognostic value of the SUVR was tested for overall survival (OS). In addition, diffusion-weighted imaging (DWI) was performed in 2 controls and 5 HBI rats (3 survivors, 2 nonsurvivors, 3 h post), and an apparent diffusion coefficient (ADC) map was generated.

Results: The nonsurvivor group showed a significantly lower SUVRWB, SUVRCB, and SUVRpons of the cerebral cortices than the survivor group (all p < 0.001). Voxel-based comparison also demonstrated significant reduction in the nonsurvivor group compared with the survivor group (family-wise error-corrected p < 0.05). However, there was no significant difference between controls and survivors. Of 3 reference regions, the SUVRpons demonstrated the largest difference between the survivor and nonsurvivor groups. With an optimal cutoff value of 1.12 (AUC 0.952, p < 0.001), the SUVRpons predicted survival outcomes with a sensitivity of 81.8% and specificity of 100%. The OS of the low SUVRpons group was significantly shorter than that the high SUVRpons group (p < 0.001). The mean ADC values of each brain region showed no significant difference according to survival outcomes.

Conclusions: These results suggest the potential utility of 18F-FDG brain PET for predicting survival in hanging-induced HBI.

그림1; 유도군 중 사망군에서 뇌피질 전반의 FDG 섭취감소를 보임.

그림2;　뇌피질 FDG섭취가 낮은 군보다 높은 군의 생존률이 유의하게 높음을 확인함.

그림3; Diffusion weighted MR은 사망군과 생존군 간 차이를 보이지 않음.

Affiliations

Daehee Kim  1   2 , Woon Jeong Lee  2 , Hye Won Lee  2 , Bom Sahn Kim  3 , Seon Hee Woo #  4 , Hai-Jeon Yoon #  5
1 Department of Emergency Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea.
2 Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
3 Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
4 Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. drme@catholic.ac.kr.
5 Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea. haijeon.yoon@gmail.com.
# Contributed equally.