1. A practical magnetic-resonance imaging score for outcome prediction in comatose cardiac arrest survivors.
- Author
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Chan WP, Nguyen C, Kim N, Tripodis Y, Gilmore EJ, Greer DM, and Beekman R
- Subjects
- Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Prognosis, Survivors statistics & numerical data, Predictive Value of Tests, Reproducibility of Results, Magnetic Resonance Imaging methods, Coma etiology, Coma diagnosis, Coma diagnostic imaging, Hypoxia-Ischemia, Brain etiology, Hypoxia-Ischemia, Brain complications, Hypoxia-Ischemia, Brain diagnosis, Hypoxia-Ischemia, Brain diagnostic imaging, Heart Arrest complications
- Abstract
Aim: Magnetic Resonance Imaging (MRI) is an important prognostic tool in cardiac arrest (CA) survivors given its sensitivity for detecting hypoxic-ischemic brain injury (HIBI), however, it is limited by poorly defined objective thresholds. To address this limitation, we evaluated a qualitative MRI score for predicting neurological outcome in CA survivors., Methods: Adult comatose CA survivors who underwent MRI were retrospectively identified at a single academic medical center. Two blinded neurointensivists qualitatively scored HIBI amongst 12 MRI brain regions. Scores were summated to form four distinct score groups: cortex, deep grey nuclei (DGN), cortex-DGN combined, and total (cortex, DGN, brainstem, and cerebellum). Poor neurological outcome was defined as Cerebral Performance Category (CPC) score 3-5 at hospital discharge. Inter-rater reliability was tested using intra-class correlation (ICC) and discrimination of poor neurological outcome assessed using area under the receiver operating curve (AUC)., Results: Our cohort included 219 patients with median time to MRI of 96 (IQR 81-110) hours. ICC (95% CI) was good to excellent across all MRI scores: cortex 0.92 (0.89-0.94), DGN 0.88 (0.80-0.92), cortex-DGN 0.94 (0.92-0.95), and total 0.93 (0.91-0.95). AUC (95% CI) for poor outcome was good across all MRI scores: cortex 0.84 (0.78-0.90), DGN 0.83 (0.77-0.89), cortex-DGN 0.83 (0.77-0.89), and total 0.83 (0.77-0.88)., Conclusion: A simplified, qualitative MRI score had excellent reliability and good discrimination for poor neurologic outcome. Further work is necessary to externally validate our findings in an independent, ideally prospective, cohort., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Dr. Tripodis receives research support from the NIH and the AMA. Dr. Greer receives research funding in the form of a grant to Boston Medical Center to conduct the INTREPID study as co-PI, including reimbursed travel to present results at major conferences. In unrelated support, Dr. Greer receives research support from NIH/NINDS, as well as personal compensation as Editor-in-Chief for Seminars in Neurology, royalties for several books, as well as medical-legal expert work.”., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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