The Usefulness of Quantitative Analysis of Blood-Brain Barrier Disruption Measured Using Contrast-Enhanced Magnetic Resonance Imaging to Predict Neurological Prognosis in Out-of-Hospital Cardiac Arrest Survivors: A Preliminary Study

Abstract

We aimed to evaluate neurological outcomes associated with blood-brain barrier (BBB) disruption using contrast-enhanced magnetic resonance imaging (CE-MRI) in out-of-hospital cardiac arrest (OHCA) survivors. This retrospective observational study involved OHCA survivors who had undergone CE-MRI for prognostication. Qualitative and quantitative analyses were performed using the presence of BBB disruption (pBD) and the BBB disruption score (sBD) in CE-MRI scans, respectively. For the sBD, 1 point was assigned for each area of BBB disruption, and 6 points were assigned when an absence of intracranial blood flow due to severe brain oedema was confirmed. The primary outcome was poor neurological outcome at 3 months (defined as cerebral performance categories 3–5). We analysed 46 CE-MRI brain scans (27 patients). Of these, 15 (55.6%) patients had poor neurological outcomes. Poor neurological outcome group patients showed a significantly higher proportion of pBD than those in the good neurological outcome group (22 (88%) vs. 6 (28.6%) patients, respectively, p < 0.001) and a higher sBD (5.0 (4.0–5.0) vs. 0.0 (0.0–1.0) patients, p < 0.001). Poor neurological outcome predictions showed that the sBD had a significantly better prognostic performance (area under the curve (AUC) 0.95, 95% confidence interval (CI) 0.84–0.99) than the pBD (AUC 0.80, 95% CI 0.65–0.90). The sBD cut-off value was >1 point (sensitivity, 96.0%; specificity, 81.0%). The sBD is a highly predictive and sensitive marker of 3-month poor neurological outcome in OHCA survivors. Multicentre prospective studies are required to determine the generalisability of these results.

Using Out-of-Hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP) Scores with Modified Objective Data to Improve Neurological Prognostic Performance for Out-of-Hospital Cardiac Arrest Survivors

“…Brain DWI was performed using a 3T scanner (Achieva, Philips Healthcare, Amsterdam, The Netherlands) before TTM. The imaging protocol and analysis used were the same as those published previously [ 14 , 15 , 16 ]. Previous studies used the percentage of voxels (PV) below different ADC thresholds and reported that PV 400 (percentage of voxels <400 × 10 −6 mm 2 /s) showed the highest odds ratio value when predicting the poor prognosis of a patient [ 14 ]; therefore, we also used PV 400.…”

2020 expert consensus statement on neuro-protection after cardiac arrest in China

“…The primary mechanism of brain injury is closely related to the time window of ischaemia and hypoxia caused by the interruption of blood flow after CA and irreversible damage occurs when cerebral blood flow is completely interrupted for more than 5 minutes. Severe brain blood barrier disruption is also strongly associated with poor neurological outcomes (8). After ROSC, the brain experiences reperfusion injury causing secondary injury.…”