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Diffusion-weighted magnetic resonance imaging for predicting the clinical outcome of comatose survivors after cardiac arrest: a cohort study.

Choi SP, Park KN, Park HK, Kim JY, Youn CS, Ahn KJ, Yim HW - Crit Care (2010)

Bottom Line: The restricted diffusion abnormalities in the cerebral cortex, caudate nucleus, putamen and thalamus were significantly different between the favourable (n = 13) and unfavourable (n = 26) outcome groups.The cortex and deep grey nuclei pattern was significantly associated with the unfavourable outcome (20 patients with unfavourable vs. 1 patient with favourable outcomes, P < 0.001).In the 22 patients with quantitative ADC analyses, severely reduced ADCs were noted in the unfavourable outcome group.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea.

ABSTRACT

Introduction: The aim of this study was to examine whether the patterns of diffusion-weighted imaging (DWI) abnormalities and quantitative regional apparent diffusion coefficient (ADC) values can predict the clinical outcome of comatose patients following cardiac arrest.

Methods: Thirty-nine patients resuscitated from out-of-hospital cardiac arrest were prospectively investigated. Within five days of resuscitation, axial DWIs were obtained and ADC maps were generated using two 1.5-T magnetic resonance scanners. The neurological outcomes of the patients were assessed using the Glasgow Outcome Scale (GOS) score at three months after the cardiac arrest. The brain injuries were categorised into four patterns: normal, isolated cortical injury, isolated deep grey nuclei injury, and mixed injuries (cortex and deep grey nuclei). Twenty-three subjects with normal DWIs served as controls. The ADC and percent ADC values (the ADC percentage as compared to the control data from the corresponding region) were obtained in various regions of the brains. We analysed the differences between the favourable (GOS score 4 to 5) and unfavourable (GOS score 1 to 3) groups with regard to clinical data, the DWI abnormalities, and the ADC and percent ADC values.

Results: The restricted diffusion abnormalities in the cerebral cortex, caudate nucleus, putamen and thalamus were significantly different between the favourable (n = 13) and unfavourable (n = 26) outcome groups. The cortical pattern of injury was seen in one patient (3%), the deep grey nuclei pattern in three patients (8%), the cortex and deep grey nuclei pattern in 21 patients (54%), and normal DWI findings in 14 patients (36%). The cortex and deep grey nuclei pattern was significantly associated with the unfavourable outcome (20 patients with unfavourable vs. 1 patient with favourable outcomes, P < 0.001). In the 22 patients with quantitative ADC analyses, severely reduced ADCs were noted in the unfavourable outcome group. The optimal cutoffs for the mean ADC and the percent ADC values determined by receiver operating characteristic (ROC) curve analysis in the cortex, caudate nucleus, putamen, and thalamus predicted the unfavourable outcome with sensitivities of 67 to 93% and a specificity of 100%.

Conclusions: The patterns of brain injury in early diffusion-weighted imaging (DWI) (less than or equal to five days after resuscitation) and the quantitative measurement of regional ADC may be useful for predicting the clinical outcome of comatose patients after cardiac arrest.

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Related in: MedlinePlus

Boxplot showing the distribution of the percent apparent diffusion coefficient values for the different brain regions of the control (white bars), favourable (striped bars), and unfavourable (grey bars) groups. The percent apparent diffusion coefficient (ADC) values were calculated using the mean normal control value of each brain region.
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Figure 3: Boxplot showing the distribution of the percent apparent diffusion coefficient values for the different brain regions of the control (white bars), favourable (striped bars), and unfavourable (grey bars) groups. The percent apparent diffusion coefficient (ADC) values were calculated using the mean normal control value of each brain region.

Mentions: The ADC value was measured in 22 patients: 8 had a favourable outcome, and 14 had an unfavourable outcome. Among the grey matter structures of 22 patients, the precentral cortex showed the lowest mean ADC value (0.598 ± 0.234 × 10-3 mm2/sec), whereas the temporal cortex had the highest mean ADC value (0.710 ± 0.277 × 10-3 mm2/sec). In all regions, the mean ADC values of the favourable outcome group were similar to those of the controls. The favourable outcome group had significantly different mean ADC values and percent ADC values than the unfavourable outcome group in the frontal, parietal, temporal, occipital, precentral, and postcentral cortices, the caudate nucleus, the putamen, and the thalamus (Table 4) (Figure 3) (P < 0.05). The unfavourable outcome group had significantly different mean ADC values than the controls in the frontal, parietal, temporal, occipital, precentral and postcentral cortices, the frontal white matter, the caudate nucleus, the putamen, and the thalamus (P < 0.05).


Diffusion-weighted magnetic resonance imaging for predicting the clinical outcome of comatose survivors after cardiac arrest: a cohort study.

Choi SP, Park KN, Park HK, Kim JY, Youn CS, Ahn KJ, Yim HW - Crit Care (2010)

Boxplot showing the distribution of the percent apparent diffusion coefficient values for the different brain regions of the control (white bars), favourable (striped bars), and unfavourable (grey bars) groups. The percent apparent diffusion coefficient (ADC) values were calculated using the mean normal control value of each brain region.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875532&req=5

Figure 3: Boxplot showing the distribution of the percent apparent diffusion coefficient values for the different brain regions of the control (white bars), favourable (striped bars), and unfavourable (grey bars) groups. The percent apparent diffusion coefficient (ADC) values were calculated using the mean normal control value of each brain region.
Mentions: The ADC value was measured in 22 patients: 8 had a favourable outcome, and 14 had an unfavourable outcome. Among the grey matter structures of 22 patients, the precentral cortex showed the lowest mean ADC value (0.598 ± 0.234 × 10-3 mm2/sec), whereas the temporal cortex had the highest mean ADC value (0.710 ± 0.277 × 10-3 mm2/sec). In all regions, the mean ADC values of the favourable outcome group were similar to those of the controls. The favourable outcome group had significantly different mean ADC values and percent ADC values than the unfavourable outcome group in the frontal, parietal, temporal, occipital, precentral, and postcentral cortices, the caudate nucleus, the putamen, and the thalamus (Table 4) (Figure 3) (P < 0.05). The unfavourable outcome group had significantly different mean ADC values than the controls in the frontal, parietal, temporal, occipital, precentral and postcentral cortices, the frontal white matter, the caudate nucleus, the putamen, and the thalamus (P < 0.05).

Bottom Line: The restricted diffusion abnormalities in the cerebral cortex, caudate nucleus, putamen and thalamus were significantly different between the favourable (n = 13) and unfavourable (n = 26) outcome groups.The cortex and deep grey nuclei pattern was significantly associated with the unfavourable outcome (20 patients with unfavourable vs. 1 patient with favourable outcomes, P < 0.001).In the 22 patients with quantitative ADC analyses, severely reduced ADCs were noted in the unfavourable outcome group.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea.

ABSTRACT

Introduction: The aim of this study was to examine whether the patterns of diffusion-weighted imaging (DWI) abnormalities and quantitative regional apparent diffusion coefficient (ADC) values can predict the clinical outcome of comatose patients following cardiac arrest.

Methods: Thirty-nine patients resuscitated from out-of-hospital cardiac arrest were prospectively investigated. Within five days of resuscitation, axial DWIs were obtained and ADC maps were generated using two 1.5-T magnetic resonance scanners. The neurological outcomes of the patients were assessed using the Glasgow Outcome Scale (GOS) score at three months after the cardiac arrest. The brain injuries were categorised into four patterns: normal, isolated cortical injury, isolated deep grey nuclei injury, and mixed injuries (cortex and deep grey nuclei). Twenty-three subjects with normal DWIs served as controls. The ADC and percent ADC values (the ADC percentage as compared to the control data from the corresponding region) were obtained in various regions of the brains. We analysed the differences between the favourable (GOS score 4 to 5) and unfavourable (GOS score 1 to 3) groups with regard to clinical data, the DWI abnormalities, and the ADC and percent ADC values.

Results: The restricted diffusion abnormalities in the cerebral cortex, caudate nucleus, putamen and thalamus were significantly different between the favourable (n = 13) and unfavourable (n = 26) outcome groups. The cortical pattern of injury was seen in one patient (3%), the deep grey nuclei pattern in three patients (8%), the cortex and deep grey nuclei pattern in 21 patients (54%), and normal DWI findings in 14 patients (36%). The cortex and deep grey nuclei pattern was significantly associated with the unfavourable outcome (20 patients with unfavourable vs. 1 patient with favourable outcomes, P < 0.001). In the 22 patients with quantitative ADC analyses, severely reduced ADCs were noted in the unfavourable outcome group. The optimal cutoffs for the mean ADC and the percent ADC values determined by receiver operating characteristic (ROC) curve analysis in the cortex, caudate nucleus, putamen, and thalamus predicted the unfavourable outcome with sensitivities of 67 to 93% and a specificity of 100%.

Conclusions: The patterns of brain injury in early diffusion-weighted imaging (DWI) (less than or equal to five days after resuscitation) and the quantitative measurement of regional ADC may be useful for predicting the clinical outcome of comatose patients after cardiac arrest.

Show MeSH
Related in: MedlinePlus