Prognostic value of diffusion-weighted MRI for post-cardiac arrest coma

To validate quantitative diffusion-weighted imaging (DWI) MRI thresholds that correlate with poor outcome in comatose cardiac arrest survivors, we conducted a clinician-blinded study and prospectively obtained MRIs from comatose patients after cardiac arrest. Consecutive comatose post-cardiac arrest...

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Bibliographic Details
Published in:Neurology Vol. 94; no. 16; p. e1684
Main Authors: Hirsch, Karen G, Fischbein, Nancy, Mlynash, Michael, Kemp, Stephanie, Bammer, Roland, Eyngorn, Irina, Tong, Julia, Moseley, Michael, Venkatasubramanian, Chitra, Caulfield, Anna Finley, Albers, Gregory
Format: Journal Article
Language:English
Published: United States 21.04.2020
Subjects:
Adult
Aged
Brain - diagnostic imaging
Coma - diagnostic imaging
Coma - etiology
Diffusion Magnetic Resonance Imaging
Female
Glasgow Outcome Scale
Heart Arrest - complications
Heart Arrest - therapy
Humans
Hypoxia-Ischemia, Brain - diagnostic imaging
Hypoxia-Ischemia, Brain - etiology
Male
Middle Aged
Post-Cardiac Arrest Syndrome - complications
Post-Cardiac Arrest Syndrome - diagnostic imaging
Prognosis
Prospective Studies
ISSN:1526-632X, 1526-632X
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Summary:To validate quantitative diffusion-weighted imaging (DWI) MRI thresholds that correlate with poor outcome in comatose cardiac arrest survivors, we conducted a clinician-blinded study and prospectively obtained MRIs from comatose patients after cardiac arrest. Consecutive comatose post-cardiac arrest adult patients were prospectively enrolled. MRIs obtained within 7 days after arrest were evaluated. The clinical team was blinded to the DWI MRI results and followed a prescribed prognostication algorithm. Apparent diffusion coefficient (ADC) values and thresholds differentiating good and poor outcome were analyzed. Poor outcome was defined as a Glasgow Outcome Scale score of ≤2 at 6 months after arrest. Ninety-seven patients were included, and 75 patients (77%) had MRIs. In 51 patients with MRI completed by postarrest day 7, the prespecified threshold of >10% of brain tissue with an ADC <650 ×10 mm /s was highly predictive for poor outcome with a sensitivity of 0.63 (95% confidence interval [CI] 0.42-0.80), a specificity of 0.96 (95% CI 0.77-0.998), and a positive predictive value (PPV) of 0.94 (95% CI 0.71-0.997). The mean whole-brain ADC was higher among patients with good outcomes. Receiver operating characteristic curve analysis showed that ADC <650 ×10 mm /s had an area under the curve of 0.79 (95% CI 0.65-0.93, < 0.001). Quantitative DWI MRI data improved prognostication of both good and poor outcomes. This prospective, clinician-blinded study validates previous research showing that an ADC <650 ×10 mm /s in >10% of brain tissue in an MRI obtained by postarrest day 7 is highly specific for poor outcome in comatose patients after cardiac arrest.
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ISSN:1526-632X
1526-632X
DOI:10.1212/WNL.0000000000009289