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Multi-Center Study of Diffusion-Weighted Imaging in Coma After Cardiac Arrest

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Abstract

Background

The ability to predict outcomes in acutely comatose cardiac arrest survivors is limited. Brain diffusion-weighted magnetic resonance imaging (DWI MRI) has been shown in initial studies to be a simple and effective prognostic tool. This study aimed to determine the predictive value of previously defined DWI MRI thresholds in a multi-center cohort.

Methods

DWI MRIs of comatose post-cardiac arrest patients were analyzed in this multi-center retrospective observational study. Poor outcome was defined as failure to regain consciousness within 14 days and/or death during the hospitalization. The apparent diffusion coefficient (ADC) value of each brain voxel was determined. ADC thresholds and brain volumes below each threshold were analyzed for their correlation with outcome.

Results

125 patients were included in the analysis. 33 patients (26 %) had a good outcome. An ADC value of less than 650 × 10−6 mm2/s in ≥10 % of brain volume was highly specific [91 % (95 % CI 75–98)] and had a good sensitivity [72 % (95 % CI 61–80)] for predicting poor outcome. This threshold remained an independent predictor of poor outcome in multivariable analysis (p = 0.002). An ADC value of less than 650 × 10−6 mm2/s in >22 % of brain volume was needed to achieve 100 % specificity for poor outcome.

Conclusions

In patients who remain comatose after cardiac arrest, quantitative DWI MRI findings correlate with early recovery of consciousness. A DWI MRI threshold of 650 × 10−6 mm2/s in ≥10 % of brain volume can differentiate patients with good versus poor outcome, though in this patient population the threshold was not 100 % specific for poor outcome.

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Acknowledgments

The authors would like to acknowledge the significant contributions of Dr. Christine Wijman to this Project and to the field of brain injury after cardiac arrest. Her presence is missed by all who knew her.

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Authors and Affiliations

  1. Stanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA

    K. G. Hirsch, M. Mlynash, I. Eyngorn, R. Pirsaheli, S. Komshian, C. A. Wijman & G. W. Albers

  2. Stanford University Oncology Division, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    A. Okada

  3. Department of Neurology, Sutter Pacific Medical Foundation, San Francisco, CA, USA

    C. Chen

  4. Mount Sinai Healthcare System, Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    S. A. Mayer

  5. Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA

    J. F. Meschia

  6. Davee Department of Neurology, Feinberg School of Medicine of Northwestern University, Northwestern University, Chicago, IL, USA

    R. A. Bernstein

  7. Department of Radiology, Athinoula A Martinos Center, Massachusetts General Hospital, Boston, MA, USA

    O. Wu

  8. Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA

    D. M. Greer

Authors
  1. K. G. Hirsch
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  2. M. Mlynash
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  3. I. Eyngorn
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  4. R. Pirsaheli
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  5. A. Okada
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  6. S. Komshian
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  7. C. Chen
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  8. S. A. Mayer
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  9. J. F. Meschia
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  10. R. A. Bernstein
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  11. O. Wu
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  12. D. M. Greer
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  13. C. A. Wijman
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  14. G. W. Albers
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Corresponding author

Correspondence to K. G. Hirsch.

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The authors declare that they have no conflict of interest.

Additional information

C. A. Wijman—deceased.

M. Mlynash—provided primary statistical analysis.

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Hirsch, K.G., Mlynash, M., Eyngorn, I. et al. Multi-Center Study of Diffusion-Weighted Imaging in Coma After Cardiac Arrest. Neurocrit Care 24, 82–89 (2016). https://doi.org/10.1007/s12028-015-0179-9

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  • DOI: https://doi.org/10.1007/s12028-015-0179-9

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