Lionel Velly1, Vincent Perlbarg2, Thomas Boulier3, Nicolas Adam4, Sebastien Delphine3, Charles-Edouard Luyt4, Valentine Battisti4, Gregory Torkomian4, Charlotte Arbelot4, Russell Chabanne5, Betty Jean5, Carol Di Perri6, Steven Laureys6, Giuseppe Citerio7, Alessia Vargiolu7, Benjamin Rohaut4, Nicolas Bruder8, Nadine Girard8, Stein Silva9, Vincent Cottenceau10, Thomas Tourdias10, Olivier Coulon1, Bruno Riou4, Lionel Naccache11, Rajiv Gupta12, Habib Benali3, Damien Galanaud4, Louis Puybasset13. 1. Institut de Neurosciences, MeCA (UMR 7289, CNRS), Aix Marseille Université, Marseille, France. 2. CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France; Institut du Cerveau et de la Moelle Epinière, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. 3. CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France. 4. AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. 5. Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France. 6. GIGA, GIGA-Consciousness, Coma Science Group, University of Liège, Liège, Belgium. 7. Milan Bicocca University, Milan, Italy; Hospital San Gerardo, Monza, Italy. 8. Assistance Publique-Hôpitaux de Marseille, Hôpital Timone Adultes, Marseille, France. 9. Neuro-Campus Baudot, Toulouse, France. 10. Hôpital Universitaire Pellegrin, Bordeaux, France. 11. Institut du Cerveau et de la Moelle Epinière, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. 12. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 13. CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. Electronic address: louis.puybasset@aphp.fr.
Abstract
BACKGROUND: Prediction of neurological outcome after cardiac arrest is a major challenge. The aim of this study was to assess whether quantitative whole-brain white matter fractional anisotropy (WWM-FA) measured by diffusion tensor imaging between day 7 and day 28 after cardiac arrest can predict long-term neurological outcome. METHODS: This prospective, observational, cohort study (part of the MRI-COMA study) was done in 14 centres in France, Italy, and Belgium. We enrolled patients aged 18 years or older who had been unconscious for at least 7 days after cardiac arrest into the derivation cohort. The following year, we recruited the validation cohort on the same basis. We also recruited a minimum of five healthy volunteers at each centre for the normalisation procedure. WWM-FA values were compared with standard criteria for unfavourable outcome, conventional MRI sequences (fluid-attenuated inversion recovery and diffusion-weighted imaging), and proton magnetic resonance spectroscopy. The primary outcome was the best achieved Glasgow-Pittsburgh Cerebral Performance Categories (CPC) at 6 months, dichotomised as favourable (CPC 1-2) and unfavourable outcome (CPC 3-5). Prognostication performance was assessed by the area under the receiver operating characteristic (ROC) curves and compared between groups. This study was registered with ClinicalTrials.gov, number NCT00577954. FINDINGS: Between Oct 1, 2006, and June 30, 2014, 185 patients were enrolled in the derivation cohort, of whom 150 had an interpretable multimodal MRI and were included in the analysis. 33 (22%) patients had a favourable neurological outcome at 6 months. Prognostic accuracy, as quantified by the area under the ROC curve, was significantly higher with the normalised WWM-FA value (area under the ROC curve 0·95, 95% CI 0·91-0·98) than with the standard criteria for unfavourable outcome or other MRI sequences. In a subsequent validation cohort of 50 patients (enrolled between April 1, 2015, and March 31, 2016), a normalised WWM-FA value lower than 0·91, set from the derivation cohort, had a negative predictive value of 71·4% (95% CI 41·9-91·6) and a positive predictive value of 100% (90·0-100), with 89·7% sensitivity (75·8-97·1) and 100% specificity (69·1-100) for the prediction of unfavourable outcome. INTERPRETATION: In patients who are unconscious 7 days after cardiac arrest, the normalised WWM-FA value, measured by diffusion tensor imaging, could be used to accurately predict neurological outcome at 6 months. This evidence requires confirmation from future large-scale trials with a strict protocol of withdrawal or limitation-of-care decisions and time window for MRI. FUNDING: French Ministry of Health, French National Agency for Research, Italian Ministry of Health, and Regione Lombardia.
BACKGROUND: Prediction of neurological outcome after cardiac arrest is a major challenge. The aim of this study was to assess whether quantitative whole-brain white matter fractional anisotropy (WWM-FA) measured by diffusion tensor imaging between day 7 and day 28 after cardiac arrest can predict long-term neurological outcome. METHODS: This prospective, observational, cohort study (part of the MRI-COMA study) was done in 14 centres in France, Italy, and Belgium. We enrolled patients aged 18 years or older who had been unconscious for at least 7 days after cardiac arrest into the derivation cohort. The following year, we recruited the validation cohort on the same basis. We also recruited a minimum of five healthy volunteers at each centre for the normalisation procedure. WWM-FA values were compared with standard criteria for unfavourable outcome, conventional MRI sequences (fluid-attenuated inversion recovery and diffusion-weighted imaging), and proton magnetic resonance spectroscopy. The primary outcome was the best achieved Glasgow-Pittsburgh Cerebral Performance Categories (CPC) at 6 months, dichotomised as favourable (CPC 1-2) and unfavourable outcome (CPC 3-5). Prognostication performance was assessed by the area under the receiver operating characteristic (ROC) curves and compared between groups. This study was registered with ClinicalTrials.gov, number NCT00577954. FINDINGS: Between Oct 1, 2006, and June 30, 2014, 185 patients were enrolled in the derivation cohort, of whom 150 had an interpretable multimodal MRI and were included in the analysis. 33 (22%) patients had a favourable neurological outcome at 6 months. Prognostic accuracy, as quantified by the area under the ROC curve, was significantly higher with the normalised WWM-FA value (area under the ROC curve 0·95, 95% CI 0·91-0·98) than with the standard criteria for unfavourable outcome or other MRI sequences. In a subsequent validation cohort of 50 patients (enrolled between April 1, 2015, and March 31, 2016), a normalised WWM-FA value lower than 0·91, set from the derivation cohort, had a negative predictive value of 71·4% (95% CI 41·9-91·6) and a positive predictive value of 100% (90·0-100), with 89·7% sensitivity (75·8-97·1) and 100% specificity (69·1-100) for the prediction of unfavourable outcome. INTERPRETATION: In patients who are unconscious 7 days after cardiac arrest, the normalised WWM-FA value, measured by diffusion tensor imaging, could be used to accurately predict neurological outcome at 6 months. This evidence requires confirmation from future large-scale trials with a strict protocol of withdrawal or limitation-of-care decisions and time window for MRI. FUNDING: French Ministry of Health, French National Agency for Research, Italian Ministry of Health, and Regione Lombardia.
Authors: Jong Woo Lee; Lasya P Sreepada; Matthew B Bevers; Karen Li; Benjamin M Scirica; Danuzia Santana da Silva; Galen V Henderson; Camden Bay; Alexander P Lin Journal: Neurology Date: 2022-01-11 Impact factor: 9.910
Authors: Samuel B Snider; David Fischer; Morgan E McKeown; Alexander Li Cohen; Frederic L W V J Schaper; Edilberto Amorim; Michael D Fox; Benjamin Scirica; Matthew B Bevers; Jong Woo Lee Journal: Neurology Date: 2022-01-11 Impact factor: 9.910
Authors: Lars W Andersen; Mathias J Holmberg; Katherine M Berg; Michael W Donnino; Asger Granfeldt Journal: JAMA Date: 2019-03-26 Impact factor: 56.272
Authors: Neill K J Adhikari; Damon C Scales; Carmen Lopez Soto; Laura Dragoi; Chinthaka C Heyn; Andreas Kramer; Ruxandra Pinto Journal: Neurocrit Care Date: 2020-02 Impact factor: 3.210
Authors: Jan Claassen; Yama Akbari; Sheila Alexander; Mary Kay Bader; Kathleen Bell; Thomas P Bleck; Melanie Boly; Jeremy Brown; Sherry H-Y Chou; Michael N Diringer; Brian L Edlow; Brandon Foreman; Joseph T Giacino; Olivia Gosseries; Theresa Green; David M Greer; Daniel F Hanley; Jed A Hartings; Raimund Helbok; J Claude Hemphill; H E Hinson; Karen Hirsch; Theresa Human; Michael L James; Nerissa Ko; Daniel Kondziella; Sarah Livesay; Lori K Madden; Shraddha Mainali; Stephan A Mayer; Victoria McCredie; Molly M McNett; Geert Meyfroidt; Martin M Monti; Susanne Muehlschlegel; Santosh Murthy; Paul Nyquist; DaiWai M Olson; J Javier Provencio; Eric Rosenthal; Gisele Sampaio Silva; Simone Sarasso; Nicholas D Schiff; Tarek Sharshar; Lori Shutter; Robert D Stevens; Paul Vespa; Walter Videtta; Amy Wagner; Wendy Ziai; John Whyte; Elizabeth Zink; Jose I Suarez Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.210