Comparison of brain computed tomography and diffusion-weighted magnetic resonance imaging to predict early neurologic outcome before target temperature management comatose cardiac arrest survivors. (September 2017)

• Record Type: Journal Article
• Authors: Jeon, Chi Heon; Park, Jung Soo; Lee, Ji Han; Kim, Hoon; Kim, Sang Chul; Park, Kyung Hye; Yi, Kyung Sik; Kim, Sun Moon; Youn, Chun Song; Kim, Young-Min; Lee, Byung Kook
• Is Part Of: Resuscitation. Volume 118(2017)
• Page Start: 21
• Page End: 26
• Publication Date: 2017-09
• Subjects: Cardiac arrest -- Prognostication -- Neuroimaging -- Computed tomography -- Diffusion-weighted magnetic resonance image; DW-MRI diffusion weighted magnetic resonance imaging -- TTM targeted temperature management -- ROSC restoration of spontaneous circulation -- CA cardiac arrest -- CT computed tomography -- GWR grey matter to white matter ratio -- AUC arear under curve -- CBNUH Chungbuk National University Hospital -- CCAS comatose cardiac arrest survivors -- ICU intensive care unit -- WLST withdrawal of life-sustaining therapy -- ERC European Resuscitation Council -- ADC apparent diffusion coefficient -- HSI high signal intensity -- HU hounsfield units -- BG basal ganglia -- CN caudate nucleus -- P putamen -- T thalamus -- CC corpus callosum -- PIC posterior limb of internal capsule -- CPC Cerebral Performance Categories -- IQR interquartile range -- CI confidence interval -- SSEP short-latency somatosensory evoked potentials -- NSE neuron-specific enolase -- EEG electroencephalography -- aEEG amplitude-integrated electroencephalography; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.06.021
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: We previously reported that diffusion-weighted magnetic resonance imaging (DW-MRI) could be used to predict neurologic outcomes before targeted temperature management (TTM) after return of spontaneous circulation (ROSC) from cardiac arrest (CA). We compared the efficacy of brain computed tomography (CT) and DW-MRI to predict neurologic outcome before TTM in comatose cardiac arrest survivors. Methods: We performed a retrospective study of CA patients treated with TTM. The brain CT and DW-MRI were both obtained before TTM. We analysed the grey matter to white matter ratio (GWR) on the brain CT and the presence of high signal intensity on DW-MRI, alone or in combination, to predict poor neurologic outcome (CPC 3–5). Results: Of 47 comatose CA patients treated with TTM, 39 patients with brain CT and DW-MRI data were included. Median time from the ROSC to the brain CT and DW-MRI was 90 min (52–150) and 175 min (118–240), respectively. There was no significant difference in predicting poor neurologic outcome between average GWR (area under the curve [AUC] 0.891, sensitivity/specificity 78.8%/100%) and DW-MRI (AUC 0.894, sensitivity/specificity 75.8%/100%) ( p = 0.963). The combination of average GWR and DW-MRI (AUC 0.939, sensitivity/specificity 87.9%/100%) improved the prediction of poor neurologic outcome rather than each one alone and in other combinations. Conclusion: Our preliminary finding suggests that DW-MRI is potentially useful for early prediction of neurologic outcome (i.e., before TTM) in CA patients. The combination of GWR on brain CT and that on DW-MRI, rather than on each modality alone, appears to improve the sensitivity for predicting neurologic outcome after ROSC from CA. Large prospective multicenter studies should be conducted to confirm these results.