Chun Song Youn1, Kyu Nam Park2, Jee Young Kim3, Clifton W Callaway4, Seung Pill Choi5, Jon C Rittenberger4, Soo Hyun Kim1, Sang Hoon Oh1, Young Min Kim1. 1. Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea. 2. Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea. Electronic address: emsky@catholic.ac.kr. 3. Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea. 4. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States. 5. Department of Emergency Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
Abstract
BACKGROUND: The aim of this study was to evaluate the changing pattern and prognostic values of diffusion-weighted imaging (DWI) at two time points in cardiac arrest patients treated with therapeutic hypothermia. METHODS: Twenty two patients with cardiac arrest who underwent two DWI studies were enrolled in the retrospective study. The first DWI was performed after the induction of therapeutic hypothermia (median 6.0h) and was repeated between 48h and 168h (second DWI, median 74h). Apparent diffusion coefficient (ADC) values were measured in the predefined brain regions, and qualitative analysis was also performed. Good neurologic outcomes were defined as Cerebral Performance Category (CPC) scores of 1 and 2. RESULTS: The ADC value tended to increase over time except the cortical regions of the poor outcome group (N=10). In the comparisons of receiver operating characteristic (ROC) curve to predict poor outcome using ADC value, postcentral cortex in the second DWI has a better association with neurological outcome (p=0.001, area under the curve (AUC)=0.996 for second DWI, AUC=0.571 for first DWI). In the same analysis using qualitative score, precentral cortex, postcentral cortex, parietal lobe, occipital lobe, caudate and putamen in the second DWI have a better association with neurological outcome. CONCLUSIONS: The changing pattern of ADC values after cardiac arrest is different according to anatomic region and neurologic status. The DWI after 48h has a better association with neurological outcome of cardiac arrest patients in both quantitative and qualitative analysis.
BACKGROUND: The aim of this study was to evaluate the changing pattern and prognostic values of diffusion-weighted imaging (DWI) at two time points in cardiac arrestpatients treated with therapeutic hypothermia. METHODS: Twenty two patients with cardiac arrest who underwent two DWI studies were enrolled in the retrospective study. The first DWI was performed after the induction of therapeutic hypothermia (median 6.0h) and was repeated between 48h and 168h (second DWI, median 74h). Apparent diffusion coefficient (ADC) values were measured in the predefined brain regions, and qualitative analysis was also performed. Good neurologic outcomes were defined as Cerebral Performance Category (CPC) scores of 1 and 2. RESULTS: The ADC value tended to increase over time except the cortical regions of the poor outcome group (N=10). In the comparisons of receiver operating characteristic (ROC) curve to predict poor outcome using ADC value, postcentral cortex in the second DWI has a better association with neurological outcome (p=0.001, area under the curve (AUC)=0.996 for second DWI, AUC=0.571 for first DWI). In the same analysis using qualitative score, precentral cortex, postcentral cortex, parietal lobe, occipital lobe, caudate and putamen in the second DWI have a better association with neurological outcome. CONCLUSIONS: The changing pattern of ADC values after cardiac arrest is different according to anatomic region and neurologic status. The DWI after 48h has a better association with neurological outcome of cardiac arrestpatients in both quantitative and qualitative analysis.
Authors: Sonya E Zhou; Mary M Barden; Emily J Gilmore; Octavio M Pontes-Neto; Gisele Sampaio Silva; Pedro Kurtz; Jamary Oliveira-Filho; Pedro Telles Cougo-Pinto; Fernando G Zampieri; Nicholas J Napoli; Jeremy J Theriot; David M Greer; Carolina B Maciel Journal: Crit Care Explor Date: 2021-01-11