Clinical MRI Interpretation for Outcome Prediction in Cardiac Arrest
- 8 May 2012
- journal article
- Published by Springer Science and Business Media LLC in Neurocritical Care
- Vol. 17 (2), 240-244
- https://doi.org/10.1007/s12028-012-9716-y
Abstract
In clinical practice, magnetic resonance imaging (MRI) is commonly used to assess the severity of a cardiac arrest patient’s cerebral injury, utilizing treating neurologists’ imaging interpretation. We sought to determine whether clinical interpretation of diffusion-weighted imaging (DWI) helps to determine poor outcome in comatose cardiac arrest patients. We analyzed 80 consecutive MRIs from patients in coma following cardiac arrest. Each study was graded as “normal” or “abnormal restricted diffusion” in pre-specified brain regions by two blinded stroke neurologists. Poor outcome was defined as a modified Rankin Scale (mRS) score >4 at 3 months. Formal interpretations of neuroimaging by non-blinded neuroradiologists were compared with the blinded reviews by the stroke neurologists. DWI abnormalities were highly sensitive (98.5 %) but only modestly specific (46.2 %) for predicting poor neurological outcome. Inter-observer reliability was moderate (kappa = 0.49 ± 0.32), with 91 % agreement between study observers, and no significant differences in study observers’ interpretations (p = 0.125). There were, however, significant differences between the study observers and the clinical neuroradiologists in identifying studies showing evidence of global hypoxic-ischemic injury (p = 0.001). The qualitative evaluation of imaging abnormalities by stroke physicians in comatose cardiac arrest patients is a highly sensitive method of predicting poor outcome, but with limited specificity.Keywords
This publication has 11 references indexed in Scilit:
- 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
- Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review)Neurology, 2006
- Ischemic injury detected by diffusion imaging 11 minutes after strokeAnnals of Neurology, 2005
- Diffusion-weighted MRI during early global cerebral hypoxia: a predictor for clinical outcome?Acta Neurologica Scandinavica, 2004
- MR Imaging in Comatose Survivors of Cardiac Resuscitation2001
- Does diffusion-weighted magnetic resonance imaging enable detection of early ischemic change following transient cerebral ischemia?Journal of the Neurological Sciences, 2000
- Diffusion-Weighted MR Imaging ofGlobal Cerebral Anoxia1999
- High Temporal Resolution Diffusion MRI of Global Cerebral Ischemia and ReperfusionJournal of Cerebral Blood Flow & Metabolism, 1996
- Imaging of the apparent diffusion coefficient for the evaluation of cerebral metabolic recovery after cardiac arrestMagnetic Resonance Imaging, 1995