Brain recovery after cardiac arrest (CA) was assessed in cats using arterial spin tagging perfusion-weighted imaging (PWI), diffusion-weighted imaging (DWI), and 1 H-spectroscopy ( 1 H-MRS). Cerebral reperfusion and metabolic recovery was monitored in the cortex and in basal ganglia for 6 h after cardiopulmonary resuscitation (CPR). Furthermore, the effects of an hypertonic/ hyperoncotic solution (7.5% NaCl/6% hydroxyl ethyl starch, HES) and a tissue-type plasminogen activator (TPA), applied during CPR, were assessed on brain recovery. CA and CPR were carried out in the MR scanner by remote control. CA for 15 Á/20 min was induced by electrical fibrillation of the heart, followed by CPR using a pneumatic vest. PWI after successful CPR revealed initial cerebral hyperperfusion followed by delayed hypoperfusion. Initial cerebral recirculation was improved after osmotic treatment. Osmotic and thrombolytic therapy were ineffective in ameliorating delayed hypoperfusion. Calculation of the apparent diffusion coefficient (ADC) from DWI demonstrated complete recovery of ion and water homeostasis in all animals. 1 H-MRS measurements of lactate suggested an extended preservation of post-ischaemic anaerobic metabolism after TPA treatment. The combination of noninvasive MR techniques is a powerful tool for the evaluation of therapeutical strategies on circulatory and metabolic cerebral recovery after experimental cerebral ischaemia. # 2003 Elsevier Ireland Ltd. All rights reserved.Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Cerebral blood flow; Magnetic resonance techniques; Hypertonic solutions; Thrombolysis
ResumoAvaliou-se a recuperação cerebral de gatos apó s paragem cardíaca (CA)..... com imagens de avaliação da perfusão (PWI) e imagens de avaliação da difusão (DWI) em espectrofotometria 1 H ( 1 H-MRS). A perfusão cerebral foi monitorizada no có rtex e nos gânglios da base durante seis horas a seguir à reanimação cardio-pulmonar (CPR). Avaliaram-se ainda os efeitos de uma solução hiperosmó tica e hiperoncó tica (NaCl hipertó nico 7.5% / hidroxi etil starch HES a 6%) e um activador tecidular do plasminogéneo (TPA), administrado durante a reanimação e avaliado na fase de recuperação. A CA e a RCP foram executadas, por controlo remoto, no scanner da ressonância magnética. A CA foi induzida, por descarga eléctrica, durante 15 Á/20 min, sendo a reanimação feita por colete pneumático. A PWI depois da CPR com sucesso evidenciou uma hiperperfusão cerebral inicial seguida de hipoperfusão. A recirculação cerebral inicial melhorou com a administração da solução osmó tica. O tratamento osmó tico e Abbreviations: ADC, apparent diffusion coefficient of water; ALS, advanced life support; CA, cardiac arrest; CBF, cerebral blood flow; CPR, cardiopulmonary resuscitation; Cr/PCr, creatine Á/phosphocreatine; DWI, diffusion-weighted imaging; HHS, hypertonic Á/hyperoncotic solution; 1 H-MRS, 1 H-proton spectroscopy; PWI, perfusion-weighted imaging; ROSC, return of spontaneous circulation; TPA, tissue-type plasminogen acti...