静息态功能磁共振成像与急性意识障碍后的临床结局：一项系统评价。
完整摘要 · 中文译文
背景与目的：严重脑损伤后急性意识障碍（DoC）患者的准确评估与预后判断仍是重大的临床挑战。静息态fMRI（rs-fMRI）测量无外部刺激时自发的、时间相关的脑活动，为支持脑功能的大规模神经网络完整性提供客观洞察。新出现的证据表明，使用rs-fMRI评估神经完整性可能改善急性DoC患者的结局预测。本综述总结了rs-fMRI作为严重脑损伤急性期评估工具的当前证据。 方法：遵循系统综述和荟萃分析优先报告条目指南，我们使用MEDLINE和Embase数据库进行了系统文献检索，时间范围为2006年1月至2026年3月。符合条件的研究包括对急性DoC（损伤后<28天）成年患者进行的同行评审实证研究，这些研究考察了rs-fMRI指标与临床结局之间的关联。系统综述方案已在PROSPERO国际系统综述前瞻性注册库注册（CRD420251085923）。 结果：在筛选的396项研究中，30项符合纳入标准。在这些研究中，共800例患者（平均年龄=48岁，69%为男性）在入住重症监护室后加权平均9.31天接受扫描。10项研究仅纳入创伤性脑损伤患者，8项纳入心脏骤停患者，2项纳入脑病患者，10项纳入混合病因患者。 最常评估的静息态网络是默认模式网络（n = 20）和执行控制网络（n = 11），其次是视觉网络（n = 6）、突显网络（n = 6）、感觉运动网络（n = 6）和听觉网络（n = 5）。在各研究中，尽管方法学存在异质性，rs-fMRI指标与结局之间的显著关联被一致报道。最常报道的患者结局为功能性或神经学状态，评估时间为出院时或伤后3至12个月。 讨论：当前证据一致表明，在脑损伤急性期获取的rs-fMRI与意识障碍（DoC）患者的神经学和功能结局相关。此外，rs-fMRI可能通过表征大规模脑网络的完整性，有助于识别更可能恢复意识并获得良好功能结局的患者。然而，显著的异质性和较小的样本量限制了研究之间的可比性。需要标准化的采集和分析框架以及更大规模的前瞻性研究，以验证rs-fMRI的临床效用并支持将其转化为脑损伤后的评估工具。
完整摘要 · 英文原文
BACKGROUND AND OBJECTIVES: Accurate assessment and prognostication of patients with acute disorders of consciousness (DoC) after severe brain injury remain a substantial clinical challenge. Resting-state fMRI (rs-fMRI) measures spontaneous, temporally correlated brain activity in the absence of external stimulation and provides objective insight into the integrity of large-scale neural networks that support brain function. Emerging evidence suggests that assessing neural integrity using rs-fMRI may improve outcome prediction in patients with acute DoC. This review summarizes the current evidence of rs-fMRI as an assessment tool during the acute phase of severe brain injury. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic literature search using MEDLINE and Embase databases from January 2006 to March 2026. Eligible studies included peer-reviewed empirical investigations of adult patients with acute DoC (<28 days postinjury) that examined associations between rs-fMRI measures and clinical outcomes. The systematic review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD420251085923). RESULTS: Of 396 studies screened, 30 met eligibility criteria. Across these studies, a total of 800 patients (mean age = 48, 69% male) were scanned at a weighted average of 9.31 days after intensive care unit admission. Ten studies included patients exclusively with traumatic brain injury, 8 with cardiac arrest, 2 with encephalopathy, and 10 included mixed etiologies. The most frequently assessed resting-state networks were the default mode (n = 20) and executive control networks (n = 11), followed by visual (n = 6), salience (n = 6), sensorimotor (n = 6), and auditory (n = 5) networks. Across studies, significant associations between rs-fMRI measures and outcome were consistently reported, despite heterogeneity in methodology. The most commonly reported patient outcomes were functional or neurologic status, assessed at hospital discharge or between 3 and 12 months postinjury. DISCUSSION: Current evidence consistently demonstrates that rs-fMRI acquired during the acute phase of brain injury is associated with neurologic and functional outcomes in patients with DoC. In addition, rs-fMRI may help identify patients more likely to recover consciousness and achieve favorable functional outcomes by characterizing the integrity of large-scale brain networks. However, substantial heterogeneity and small sample sizes limit comparability across studies. Standardized acquisition and analysis frameworks, along with larger prospective studies, are needed to validate the clinical utility of rs-fMRI and support translation into an assessment tool after brain injury.