Document Detail

Prognostic value of brain diffusion-weighted imaging after cardiac arrest.
MedLine Citation:
PMID:  19399889     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Case Reports; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of neurology     Volume:  65     ISSN:  1531-8249     ISO Abbreviation:  Ann. Neurol.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-04     Completed Date:  2009-05-19     Revised Date:  2014-04-29    
Medline Journal Info:
Nlm Unique ID:  7707449     Medline TA:  Ann Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  394-402     Citation Subset:  IM    
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MeSH Terms
Brain / metabolism,  pathology*
Brain Mapping
Diffusion Magnetic Resonance Imaging / methods*
Disease Progression
Feasibility Studies
Heart Arrest / pathology*
Image Processing, Computer-Assisted / methods
Middle Aged
Neurologic Examination
Predictive Value of Tests
Prospective Studies
Statistics, Nonparametric
Time Factors
Young Adult
Grant Support
Comment In:
Ann Neurol. 2009 Apr;65(4):364-6   [PMID:  19399840 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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