| Prognostic value of brain diffusion-weighted imaging after cardiac arrest. | |
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MedLine Citation:
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PMID: 19399889 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Outcome prediction is challenging in comatose postcardiac arrest survivors. We assessed the feasibility and prognostic utility of brain diffusion-weighted magnetic resonance imaging (DWI) during the first week. METHODS: Consecutive comatose postcardiac arrest patients were prospectively enrolled. AWI data of patients who met predefined specific prognostic criteria were used to determine distinguishing apparent diffusion coefficient (ADC) thresholds. Group 1 criteria were death at 6 months and absent motor response or absent pupillary reflexes or bilateral absent cortical responses at 72 hours or vegetative at 1 month. Group 2 criterion was survival at 6 months with a Glasgow Outcome Scale score of 4 or 5 (group 2A) or 3 (group 2B). The percentage of voxels below different ADC thresholds was calculated at 50 x 10(-6) mm(2)/sec intervals. RESULTS: Overall, 86% of patients underwent DWI. Fifty-one patients with 62 brain DWIs were included. Forty patients met the specific prognostic criteria. The percentage of brain volume with an ADC value less than 650 to 700 x 10(-6)mm(2)/sec best differentiated between Group 1 and Groups 2A and 2B combined (p < 0.001), whereas the 400 to 450 x 10(-6)mm(2)/sec threshold best differentiated between Groups 2A and 2B (p = 0.003). The ideal time window for prognostication using DWI was between 49 and 108 hours after the arrest. When comparing DWI in this time window with the 72-hour neurological examination, DWI improved the sensitivity for predicting poor outcome by 38% while maintaining 100% specificity (p = 0.021). INTERPRETATION: Quantitative DWI in comatose postcardiac arrest survivors holds promise as a prognostic adjunct. |
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Authors:
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Christine A C Wijman; Michael Mlynash; Anna Finley Caulfield; Amie W Hsia; Irina Eyngorn; Roland Bammer; Nancy Fischbein; Gregory W Albers; Michael Moseley |
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Publication Detail:
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Type: Case Reports; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of neurology Volume: 65 ISSN: 1531-8249 ISO Abbreviation: Ann. Neurol. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-05-04 Completed Date: 2009-05-19 Revised Date: 2010-09-27 |
Medline Journal Info:
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Nlm Unique ID: 7707449 Medline TA: Ann Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 394-402 Citation Subset: IM |
Affiliation:
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Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94304, USA. cwijman@stanford.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Brain / metabolism, pathology* Brain Mapping Diffusion Magnetic Resonance Imaging / methods* Disease Progression Feasibility Studies Female Heart Arrest / pathology* Humans Image Processing, Computer-Assisted / methods Male Middle Aged Neurologic Examination Predictive Value of Tests Prognosis Prospective Studies Statistics, Nonparametric Time Factors Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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2R01EB002711/EB/NIBIB NIH HHS; R01 NS034866-07/NS/NINDS NIH HHS; R01NS34866/NS/NINDS NIH HHS |
| Comments/Corrections | |
Comment In:
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Ann Neurol. 2009 Apr;65(4):364-6
[PMID:
19399840
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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