Prognostic value of diffusion-weighted MRI for post-cardiac arrest coma
- 8 April 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 94 (16), e1684-e1692
- https://doi.org/10.1212/wnl.0000000000009289
Abstract
Objective To validate quantitative diffusion-weighted imaging (DWI) MRI thresholds that correlate with poor outcome in comatose cardiac arrest survivors, we conducted a clinician-blinded study and prospectively obtained MRIs from comatose patients after cardiac arrest. Methods Consecutive comatose post-cardiac arrest adult patients were prospectively enrolled. MRIs obtained within 7 days after arrest were evaluated. The clinical team was blinded to the DWI MRI results and followed a prescribed prognostication algorithm. Apparent diffusion coefficient (ADC) values and thresholds differentiating good and poor outcome were analyzed. Poor outcome was defined as a Glasgow Outcome Scale score of ≤2 at 6 months after arrest. Results Ninety-seven patients were included, and 75 patients (77%) had MRIs. In 51 patients with MRI completed by postarrest day 7, the prespecified threshold of >10% of brain tissue with an ADC −6 mm2/s was highly predictive for poor outcome with a sensitivity of 0.63 (95% confidence interval [CI] 0.42–0.80), a specificity of 0.96 (95% CI 0.77–0.998), and a positive predictive value (PPV) of 0.94 (95% CI 0.71–0.997). The mean whole-brain ADC was higher among patients with good outcomes. Receiver operating characteristic curve analysis showed that ADC −6 mm2/s had an area under the curve of 0.79 (95% CI 0.65–0.93, p < 0.001). Quantitative DWI MRI data improved prognostication of both good and poor outcomes. Conclusions This prospective, clinician-blinded study validates previous research showing that an ADC 10% of brain tissue in an MRI obtained by postarrest day 7 is highly specific for poor outcome in comatose patients after cardiac arrest.Keywords
This publication has 24 references indexed in Scilit:
- CorrectionCirculation, 2013
- Heart Disease and Stroke Statistics—2013 UpdateCirculation, 2013
- Prognosis After Cardiac Arrest and Hypothermia: A New ParadigmCurrent Neurology and Neuroscience Reports, 2010
- Sedation Confounds Outcome Prediction in Cardiac Arrest Survivors Treated with HypothermiaNeurocritical Care, 2010
- Temporal and Spatial Profile of Brain Diffusion-Weighted MRI After Cardiac ArrestStroke, 2010
- Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR ImagingRadiology, 2009
- Prognostic value of brain diffusion‐weighted imaging after cardiac arrestAnnals of Neurology, 2009
- Early prognosis in coma after cardiac arrest: a prospective clinical, electrophysiological, and biochemical study of 60 patients.Journal of Neurology, Neurosurgery & Psychiatry, 1996
- Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.Circulation, 1991
- Sudden cardiac death -- 1978.Circulation, 1979