Prognostic value of gray matter to white matter ratio in hypoxic and non-hypoxic cardiac arrest with non-cardiac etiology

Lee, Byung Kook; Kim, Won Young; Shin, Jonghwan; Oh, Joo Suk; Wee, Jung Hee; Cha, Kyoung‐Chul; Park, Yooseok; Choi, Jae Hyung; Jeung, Kyung Woon

doi:10.1016/j.ajem.2016.05.063

Cited by 47 publications

(33 citation statements)

References 25 publications

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“…Finally, as for other predictors, an additional source of variability may be represented by variations in case mix, notably, in the aetiology of arrest. Results from two studies included in our review show that the sensitivity of GWR was lower in patients with arrest from cardiac aetiology [81] vs. those with arrest from non-cardiac aetiology [82]. Intracerebral post-anoxic cytotoxic oedema reduces water diffusivity and is detected on brain MRI as a hyperintensity on diffusion-weighted imaging (DWI) with corresponding low apparent diffusion coefficient (ADC) values.…”

Section: Imagingmentioning

confidence: 95%

“…Target temperature varied across studies (ESM Table E3). Fifteen studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] were included for clinical examination, 12 for biomarkers [37][38][39][40][41][42][43][44][45][46][47][48], 26 for electrophysiology , and 15 for imaging [75][76][77][78][79][80][81][82][83][84][85][86][87][88][89], while 26 studies were included for more than one prognostic modality.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fifteen studies assessed the accuracy of the ratio between the densities (in Hounsfield units) of grey matter and white matter (GWR), on brain CT [27,75,78,[80][81][82][83]86,87,[100][101][102][103]110,112,115]. Densities were sampled in various components of the basal ganglia (caudate, putamen, and thalamus) for the grey matter, in the corpus callosum and in the posterior limb of the internal capsule for the white matter, and in the cerebrum for both (centrum semiovale, upper convexity area).…”

Section: Imaging (Tables 49 50 51 52 53 54) Grey Matter/white Mamentioning

confidence: 99%

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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Section: Imagingmentioning

confidence: 95%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Imaging (Tables 49 50 51 52 53 54) Grey Matter/white Mamentioning

confidence: 99%

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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“…In addition, differences in timing of the CT and GWR thresholds, ranging from \1.18 when the imaging is performed within 48 h from arrest [54] to\1.22 if within 24 h [55], make an exact recommendation difficult. Moreover, a low GWR was more effective to predict the neurologic outcome in a CA with hypoxic etiology rather than a nonhypoxic etiology [57]. In patients who were treated with TTM, an averaged GWR (taken at the basal ganglia and cortical levels) of \1.16 was predictive of poor outcome [58].…”

Section: Brain Imaging (Ct-scan and Mri)mentioning

confidence: 96%

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Taccone¹,

Colpaert²,

Waele³

et al. 2015

Resuscitation

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The prognosis of patients who are admitted to the hospital after cardiac arrest often relies on neurological examination, which could be significantly influenced by the use of sedative drugs or the implementation of targeted temperature management. The need for early and accurate prognostication is crucial as up to 15-20% of patients could be considered as having a poor outcome and may undergo withdrawal of life-sustaining therapies while a complete neurological recovery is still possible. As current practice in Belgium is still based on a very early assessment of neurological function in these patients, the Belgian Society of Intensive Care Medicine created a multidisciplinary Task Force to provide an optimal approach for monitoring and refine prognosis of CA survivors. This Task Force underlined the importance to use a multimodal approach using several additional tools (e.g., electrophysiological tests, neuroimaging, biomarkers) and to refer cases with uncertain prognosis to specialized centers to better evaluate the extent of brain injury in these patients.

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“…This suggests that predictive value of fractional anisotropy varies depending on the used imaging time window [29]. Conventional DWI MRI seems to perform better than DTI/MRS in the early phase [30,31].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Prognostic Value of Early Phase 1H Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging With Neuron-Specific Enolase at 72 Hours in Comatose Survivors of Out-of-hospital Cardiac Arrest – A Sub-Study of the Xe-Hypotheca Trial

Koskensalo¹,

Virtanen²,

Saunavaara³

et al. 2020

Preprint

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BackgroundGuidelines recommend brain imaging for neurological prognostication after out-of-hospital cardiac arrest (OHCA). We aimed to evaluate the predictive accuracy of early phase diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1H-MRS) combined with neuron-specific enolase (NSE) and selected clinical variables for poor neurological outcome after OHCA.MethodsIn 92 patients with complete data set, the predictive accuracy of DTI, 1H-MRS, and NSE at 72h for poor neurological outcome (mRS 3-6) at six months were assessed by area under the receiver operating characteristic (ROC) curve as predetermined in the protocol. Additional post-hoc analyses were also performed to find a model with the best predictive power for poor neurological outcome. The brain imaging was performed in a median (IQR) time of 53 hours (47-64) after OHCA.ResultsAt six-months, 31 patients had mRS 3-6, considered to reflect a poor neurological outcome. There was no significant difference between area under ROC curve of 0.73 (95% CI 0.62-0.84) for DTI, 0.78 (0.68-0.88) for 1H-MRS and 0.85 (0.76-0.93) for NSE at 72h for predicting poor outcome at 6 months. In the post-hoc analysis, the combination of DTI, 1H-MRS, and NSE with motor score at 72 hours and epileptic seizures provided the best predictive power with area under ROC curve of 0.98 (95% CI 0.96 – 1.00) as compared to 0.92 (0.86 − 0.97) for DTI, 1H-MRS and NSE at 72 hours alone (p = 0.009).ConclusionsNeither early stage DTI nor 1H-MRS imaging was better than NSE at 72h in predicting poor outcome in this patient group. Although the addition of neuroimaging to the best model using current clinical and laboratory parameters improved the diagnostic performance, the costs and challenges of MR imaging of critically ill patients may outweigh this small benefit. Trial registrationClinicalTrials.gov NCT00879892. Registered on 13 April 2009.

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Prognostic value of gray matter to white matter ratio in hypoxic and non-hypoxic cardiac arrest with non-cardiac etiology

Cited by 47 publications

References 25 publications

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Comparison of Prognostic Value of Early Phase 1H Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging With Neuron-Specific Enolase at 72 Hours in Comatose Survivors of Out-of-hospital Cardiac Arrest – A Sub-Study of the Xe-Hypotheca Trial

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