Repeated diffusion weighted imaging in comatose cardiac arrest patients with therapeutic hypothermia

Youn, Chun Song; Park, Kyu Nam; Kim, Jee Young; Callaway, Clifton W.; Choi, Seung Pill; Rittenberger, Jon C.; Kim, Soo Hyun; Oh, Sang Hoon; Kim, Young Min

doi:10.1016/j.resuscitation.2015.06.029

Cited by 29 publications

(16 citation statements)

References 32 publications

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“…It is recommended to perform MRI between 24-48 hours and 7 days after CA. 87 Given the current relatively low level of evidence, 88 diffuse structural signs of post-anoxic injury on either brain CT or MRI seem less robust predictors than brainstem reflexes and electrophysiological findings. 13 Difficulties inherent to transporting critically ill patients to the scanner and the still unclear prognostic value of imaging techniques (especially when evaluated only qualitatively) explain why they remain optional in most prognostication algorithms.…”

Section: Brain Computed Tomography (Ct)mentioning

confidence: 99%

Neurological prognostication of outcome in patients in coma after cardiac arrest

Rossetti

Rabinstein

Oddo

2016

The Lancet Neurology

266

278

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Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Neurologists are increasingly confronted with raised expectations of next of kin and the necessity to provide early predictions of long-term prognosis. During the past decade, as technology and clinical evidence have evolved, post-cardiac arrest prognostication has moved towards a multimodal paradigm combining clinical examination with additional methods, consisting of electrophysiology, blood biomarkers, and brain imaging, to optimise prognostic accuracy. Prognostication should never be based on a single indicator; although some variables have very low false positive rates for poor outcome, multimodal assessment provides resassurance about the reliability of a prognostic estimate by offering concordant evidence.

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Section: Brain Computed Tomography (Ct)mentioning

confidence: 99%

Neurological prognostication of outcome in patients in coma after cardiac arrest

Rossetti

Rabinstein

Oddo

2016

The Lancet Neurology

266

278

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“…9–18 Recent work has tested predictive value of multiple modalities, but the ideal combination is not known. 28–32 Importantly, not all tests are necessary for all patients and some facilities may not offer all of these modalities.…”

Section: Discussionmentioning

confidence: 99%

Combination of initial neurologic examination, quantitative brain imaging and electroencephalography to predict outcome after cardiac arrest

2017

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Background Prognosticating outcome following cardiac arrest is challenging and requires a multimodal approach. We tested the hypothesis that the combination of initial neurologic examination, quantitative analysis of head computed tomography (CT) and continuous EEG (cEEG) improve outcome prediction after cardiac arrest. Methods Review of consecutive patients receiving head CT within 24hrs and cEEG monitoring between April 2010 and May 2013. Initial neurologic examination (Full Outline of UnResponsiveness_Brainstem reflexes (FOUR_B) score and initial Pittsburgh Post-Cardiac Arrest Category (PCAC)), gray matter to white matter attenuation ratio (GWR) on head CT and cEEG patterns were evaluated. The primary outcome was in-hospital mortality. Results Of 240 subjects, 70 (29%) survived and 22 (9%) had a good neurologic outcome at hospital discharge. Combined determination of GW ratio and malignant cEEG had an incremental predictive value (AUC: 0.776 for mortality and 0.792 for poor neurologic outcome), with 0% false positive rate when compared with either test alone (AUC of GW ratio: 0.683 for mortality and 0.726 for poor outcome, AUC of malignant cEEG: 0.650 for mortality and 0.647 for poor outcome). Addition of FOUR_B or PCAC to this model improved prediction of mortality (p=0.014 for FOUR_B and 0.001 for PCAC) but not of poor outcome (p=0.786 for FOUR_B and 0.099 for PCAC). Conclusions Combining GWR with cEEG was superior to any individual test for predicting mortality and neurologic outcome. Addition of clinical variables further improved prognostication for mortality but not neurologic outcome. These preliminary data support a multi-modal prognostic workup in this population.

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“…After cerebral hypoxia, impaired function of ion pumps in cell membrane results in cytotoxic edema, which is reflected by the low ADC values (4). Reduced ADC values are correlated with poor neurological outcome in cardiac arrest patients (2,5). However, only a few studies reported changes involving PWI in patients with cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

Kim

Park

Lim

2018

Investig Magn Reson Imaging

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Therapeutic hypothermia in cardiac arrest patients is associated with favorable outcomes mediated via neuroprotective mechanisms. We report a rare case of a 32-year-old male who demonstrated complete recovery of signal changes on perfusion-weighted imaging after therapeutic hypothermia due to cardiac arrest. Brain MRI with perfusion-weighted imaging, performed three days after ending the hypothermia therapy, showed a marked decrease in relative cerebral blood flow (rCBF) and delay in mean transit time (MTT) in the bilateral basal ganglia, thalami, brain stem, cerebellum, occipitoparietal cortex, and frontotemporal cortex. However, no cerebral ischemia was not noted on diffusion-weighted imaging (DWI) or fluidattenuated inversion recovery (FLAIR) sequences. A follow-up brain MRI after one week showed complete resolution of the perfusion deficit and the patient was discharged without any neurologic sequelae. The mechanism and interpretation of the perfusion changes in cardiac arrest patients treated with therapeutic hypothermia are discussed.

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Repeated diffusion weighted imaging in comatose cardiac arrest patients with therapeutic hypothermia

Cited by 29 publications

References 32 publications

Neurological prognostication of outcome in patients in coma after cardiac arrest

Neurological prognostication of outcome in patients in coma after cardiac arrest

Combination of initial neurologic examination, quantitative brain imaging and electroencephalography to predict outcome after cardiac arrest

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

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