Gray matter to white matter ratio for predicting neurological outcomes in patients treated with target temperature management after cardiac arrest: A systematic review and meta-analysis

Na, MinKyun; Kim, Wonhee; Lim, Taeho; Jang, Bo‐Hyoung; Cho, Youngsuk; Choi, Kyu-Sun; Shin, Hyungoo; Ahn, Chiwon; Lee, Juncheol; Kim, Jae Guk

doi:10.1016/j.resuscitation.2018.08.024

Cited by 52 publications

(52 citation statements)

References 34 publications

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“…Loss of gray–white matter ratio is indicative of cerebral edema and felt to correlate with hypoxic ischemic changes in different areas of the brain. In a 2018 meta‐analysis that included 1150 patients from retrospective studies, the pooled sensitivity and specificity for loss of gray–white matter ratio at predicting a poor neurologic outcome was 29% and 97%, respectively 37 . Similar findings were reported in a 2019 meta‐analysis of 20 studies and 2327 patients where the sensitivity and specificity of loss of gray–white matter ratio on CT was 44% and 97%, respectively 38 .…”

Section: Imaging Studiessupporting

confidence: 68%

Neurologic prognostication after resuscitation from cardiac arrest

2020

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Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

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Section: Imaging Studiessupporting

confidence: 68%

Neurologic prognostication after resuscitation from cardiac arrest

2020

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“…An additional cause of discrepancies is the variability of the technology used to measure biomarkers, which can lead to significant systematic errors between technologies [40,41]. Sixth, basal ganglia seem to be the best region to calculate the GWR for predicting a neurological outcome after CA [42]. The AUC of the basal ganglia GWR for predicting the neurological outcomes of our cohort was higher than that of the cerebrum GWR and average GWR (0.625 vs. 0.599 and 0.619, respectively).…”

Section: Discussionmentioning

confidence: 99%

Neuron-specific enolase and neuroimaging for prognostication after cardiac arrest treated with targeted temperature management

Kim

Park

et al. 2020

PLoS ONE

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Background Prognostication after cardiac arrest (CA) needs a multimodal approach, but the optimal method is not known. We tested the hypothesis that the combination of neuron-specific enolase (NSE) and neuroimaging could improve outcome prediction after CA treated with targeted temperature management (TTM). Methods A retrospective observational cohort study was performed on patients who underwent at least one NSE measurement between 48 and 72 hr; received both a brain computed tomography (CT) scan within 24 hr and diffusion-weighted magnetic resonance imaging (DW-MRI) within 7 days after return of spontaneous circulation (ROSC); and were treated with TTM after out-of-hospital CA between 2009 and 2017 at the Seoul St. Mary's Hospital in Korea. The primary outcome was a poor neurological outcome at 6 months after CA, defined as a cerebral performance category of 3-5. Results A total of 109 subjects underwent all three tests and were ultimately included in this study. Thirty-four subjects (31.2%) experienced good neurological outcomes at 6 months after CA. The gray matter to white matter attenuation ratio (GWR) was weakly correlated with the mean apparent diffusion coefficient (ADC), PV400 and NSE (Spearman's rho: 0.359,-0.362 and-0.263, respectively). NSE was strongly correlated with the mean ADC and PV400 (Spearman's rho:-0.623 and 0.666, respectively). Serum NSE had the highest predictive value among the single parameters (area under the curve (AUC) 0.912, sensitivity 70.7% for maintaining 100% specificity). The combination of a DWI parameter (mean ADC or PV400)

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“…In normal brain CTs, gray-white ratio is ≈1.30-1.40. Although intact gray-white ratio does not necessarily forecast a good neurological outcome, loss of differentiation with a gray-white ratio <1.20 is associated with much lower probability of neurological recovery, 65,67,68 and a gray-white ratio <1.10 is 100%-specific for poor neurological outcome. 69 Qualitative signs of severe edema, which correlate with lower gray-white ratio, include effacement of the cerebral sulci, loss of basal cisterns including the prepontine space and quadrigeminal plate, F I G U R E 2 Calculation of gray-white ratio on brain computed tomography (CT).…”

Section: Brain Computed Tomographymentioning

confidence: 96%

“…the gray-white ratio. 67 Simple locations to measure this ratio are at the level of the basal ganglia, where the caudate nucleus and posterior limb of the internal capsule can be measured in a single CT slice ( Figure 2).…”

Section: Brain Computed Tomographymentioning

confidence: 99%

Early risk stratification after resuscitation from cardiac arrest

et al. 2020

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Emergency clinicians often resuscitate cardiac arrest patients, and after acute resuscitation, clinicians face multiple decisions regarding disposition. Recent evidence suggests that out‐of‐hospital cardiac arrest patients with return of spontaneous circulation have higher odds of survival to hospital discharge, long‐term survival, and improved functional outcomes when treated at centers that can provide advanced multidisciplinary care. For community clinicians, a high volume cardiac arrest center may be hours away. While current guidelines recommend against neurological prognostication in the first hours or days after return of spontaneous circulation, there are early findings suggestive of irrecoverable brain injury in which the patient would receive no benefit from transfer. In this Concepts article, we describe a simplified approach to quickly evaluate neurological status in cardiac arrest patients and identify findings concerning for irrecoverable brain injury. Characteristics of the arrest and resuscitation, initial neurological assessment, and brain computed tomography together can identify patients with high likelihood of irrecoverable anoxic injury. Patients who may benefit from centers with access to continuous electroencephalography are discussed. This approach can be used to identify patients who may benefit from rapid transfer to cardiac arrest centers versus those who may benefit from care close to home. Risk stratification also can provide realistic expectations for recovery to families.

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Gray matter to white matter ratio for predicting neurological outcomes in patients treated with target temperature management after cardiac arrest: A systematic review and meta-analysis

Cited by 52 publications

References 34 publications

Neurologic prognostication after resuscitation from cardiac arrest

Neurologic prognostication after resuscitation from cardiac arrest

Neuron-specific enolase and neuroimaging for prognostication after cardiac arrest treated with targeted temperature management

Early risk stratification after resuscitation from cardiac arrest

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