Prognostic Value of A Qualitative Brain MRI Scoring System After Cardiac Arrest

• Published in: Journal of neuroimaging Vol. 25; no. 3; pp. 430 - 437
• Main Authors: Hirsch, Karen G., Mlynash, Michael, Jansen, Sofie, Persoon, Suzanne, Eyngorn, Irina, Krasnokutsky, Michael V., Wijman, Christine A.C., Fischbein, Nancy J.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-05-2015; Wiley Subscription Services, Inc
• Subjects: Algorithms; anoxic brain injury; cardiac arrest; Coma - etiology; Coma - pathology; Diffusion weighted MRI; Female; Heart Arrest - complications; Heart Arrest - diagnosis; Humans; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Imaging; Male; Middle Aged; Neuroimaging; NMR; Nuclear magnetic resonance; Observer Variation; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Single-Blind Method; Diffusion weighted MRI; anoxic brain injury; cardiac arrest; prognosis
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12143

ABSTRACT
BACKGROUND AND PURPOSE
To develop a qualitative brain magnetic resonance imaging (MRI) scoring system for comatose cardiac arrest patients that can be used in clinical practice.
METHODS
Consecutive comatose postcardiac arrest patients were prospectively enrolled. Routine MR brain sequences were scored by two independent blinded experts. Predefined brain regions were qualitatively scored on the fluid‐attenuated inversion recovery (FLAIR) and diffusion‐weighted imaging (DWI) sequences according to the severity of the abnormality on a scale from 0 to 4. The mean score of the raters was used. Poor outcome was defined as death or vegetative state at 6 months.
RESULTS
Sixty‐eight patients with 88 brain MRI scans were included. Median time from the arrest to the initial MRI was 77 hours (IQR 58‐144 hours). At 100% specificity, the “cortex score” performed best in predicting unfavorable outcome with a sensitivity of 55%‐60% (95% CI 41‐74) depending on time window selection. When comparing the “cortex score” with historically used predictors for poor outcome, MRI improved the sensitivity for poor outcome over conventional predictors by 27% at 100% specificity.
CONCLUSIONS
A qualitative MRI scoring system helps assess hypoxic‐ischemic brain injury severity following cardiac arrest and may provide useful prognostic information in comatose cardiac arrest patients.