This study aimed to explore the characteristics of abnormal regional resting-state functional magnetic resonance imaging (rs-fMRI) activity in comatose patients in the early period after cardiac arrest (CA), and to investigate their relationships with neurological outcomes. We also explored the correlations between jugular venous oxygen saturation (SjvO2) and rs-fMRI activity in resuscitated comatose patients. We also examined the relationship between the amplitude of the N20-baseline and the rs-fMRI activity within the intracranial conduction pathway of somatosensory evoked potentials (SSEPs). Between January 2021 and January 2024, eligible post-resuscitated patients were screened to undergo fMRI examination. The amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) of rs-fMRI blood oxygenation level-dependent (BOLD) signals were used to characterize regional neural activity. Neurological outcomes were evaluated using the Glasgow–Pittsburgh cerebral performance category (CPC) scale at 3 months after CA. In total, 20 healthy controls and 31 post-resuscitated patients were enrolled in this study. The rs-fMRI activity of resuscitated patients revealed complex changes, characterized by increased activity in some local brain regions and reduced activity in others compared to healthy controls (P < 0.05). However, the mean ALFF values of the whole brain were significantly greater in CA patients (P = 0.011). Among the clusters of abnormal rs-fMRI activity, the cluster values of ALFF in the left middle temporal gyrus and inferior temporal gyrus and the cluster values of ReHo in the right precentral gyrus, superior frontal gyrus and middle frontal gyrus were strongly correlated with the CPC score (P < 0.001). There was a strong correlation between the mean ALFF and SjvO2 in CA patients (r = 0.910, P < 0.001). The SSEP N20-baseline amplitudes in CA patients were negatively correlated with thalamic rs-fMRI activity (all P < 0.001). This study revealed that abnormal rs-fMRI BOLD signals in resuscitated patients showed complex changes, characterized by increased activity in some local brain regions and reduced activity in others. Abnormal BOLD signals were associated with neurological outcomes in resuscitated patients. The mean ALFF values of the whole brain were closely related to SjvO2 levels, and changes in the thalamic BOLD signals correlated with the N20-baseline amplitudes of SSEP responses. NCT05966389 (Registered July 27, 2023).

中文翻译：

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心脏骤停昏迷幸存者早期静息态功能性 MRI 活动的改变：一项前瞻性队列研究


本研究旨在探讨心脏骤停 （CA） 后早期昏迷患者区域静息态功能磁共振成像 （rs-fMRI） 活动异常的特点，并探讨它们与神经系统结局的关系。我们还探讨了复苏昏迷患者颈静脉血氧饱和度 （SjvO2） 与 rs-fMRI 活性之间的相关性。我们还检查了 N20 基线的振幅与体感诱发电位 （SSEPs） 颅内传导通路内 rs-fMRI 活性之间的关系。在 2021 年 1 月至 2024 年 1 月期间，符合条件的复苏后患者接受了 fMRI 检查。rs-fMRI 血氧合水平依赖性 （BOLD） 信号的低频波动幅度 （ALFF） 、分数 ALFF （fALFF） 和区域均匀性 （ReHo） 用于表征区域神经活动。在 CA 后 3 个月使用 Glasgow-Pittsburgh 脑性能类别 （CPC） 量表评估神经系统结局。本研究共纳入了 20 名健康对照者和 31 名复苏后患者。复苏患者的 rs-fMRI 活性揭示了复杂的变化，与健康对照相比，其特征是某些局部脑区的活动增加，而其他脑区的活动减少 （P < 0.05）。然而，CA 患者全脑的平均 ALFF 值显着更高 （P = 0.011）。在 rs-fMRI 活动异常的聚类中，左侧颞中回和颞下回 ALFF 的聚类值以及右侧中央前回、额上回和额中回的 ReHo 聚类值与 CPC 评分密切相关 （P < 0.001）。 CA 患者的平均 ALFF 和 SjvO2 之间存在很强的相关性 （r = 0.910，P < 0.001）。CA 患者 SSEP N20 基线振幅与丘脑 rs-fMRI 活性呈负相关 （P均 < 0.001）。这项研究表明，复苏患者的异常 rs-fMRI BOLD 信号表现出复杂的变化，其特征是某些局部大脑区域的活动增加，而其他区域的活动减少。异常 BOLD 信号与复苏患者的神经系统结局相关。全脑平均 ALFF 值与 SjvO2 水平密切相关，丘脑 BOLD 信号的变化与 SSEP 反应的 N20 基线振幅相关。NCT05966389（2023 年 7 月 27 日注册）。