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Distinct pattern of microsusceptibility changes on brain magnetic resonance imaging (MRI) in critically ill patients

Majda M Thurnher1, Jasmina Boban2, Martin Röggla3

  • 1Department for Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria. majda.thurnher@meduniwien.ac.at.

Neuroradiology
|March 1, 2021
PubMed
Abstract

Insights

Critically-ill patients on mechanical ventilation or ECMO show distinct brain susceptibility (SWI) abnormalities. These findings suggest a probable link to respiratory failure and hypoxemia in intensive care unit (ICU) patients.

Area of Science:

  • Neuroimaging
  • Critical Care Medicine
  • Radiology

Background:

  • Susceptibility Weighted Imaging (SWI) abnormalities in intensive care unit (ICU) patients have uncertain origins and clinical significance.
  • Recent observations link SWI-hypointense foci to neurological complications of SARS-COV-2 infection.

Purpose of the Study:

  • To describe patterns of susceptibility brain changes in critically-ill patients.
  • Focus on patients undergoing mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO).

Main Methods:

  • Retrospective study of 250 ICU patients with brain MRI (January 2011 - May 2020).
  • Analysis of 15 patients (median age 47.7 years) who underwent mechanical ventilation/ECMO and showed SWI abnormalities.

Main Results:

  • SWI abnormalities were common, located at the white-gray matter interface, subcortical white matter, and surrounding nuclei (92.8%).
  • Infratentorial involvement occurred in 57.1% of patients.
  • Affected brain regions included the corpus callosum (71.4%), internal capsule (35.7%), and midbrain/pons (42.8%).

Conclusions:

  • Distinct patterns of diffuse brain SWI susceptibilities were observed in critically-ill patients on mechanical ventilation/ECMO.
  • Etiology remains uncertain, but probable explanations include mechanical ventilation, prolonged respiratory failure, and hypoxemia.
Keywords:
BrainExtracorporeal membrane oxygenation (ECMO)Magnetic resonance imaging (MRI)Mechanical ventilationMicrobleeds

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