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• W2626386101 abstract "Background Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam. Methods We identified 69 patients who had MRIs within seven days of arrest and used a semi-automated algorithm to perform quantitative volumetric analysis of apparent diffusion coefficient (ADC) sequences at various thresholds. Area under receiver operating characteristic curves (ROC-AUC) were estimated to compare predictive values of quantitative MRI with pupillary exam at days 3, 5 and 7 post-arrest, for persistence of coma and functional outcomes at discharge. Cerebral Performance Category scores of 3–4 were considered poor outcome. Results Excluding patients where life support was withdrawn, ≥2.8% diffusion restriction of the entire brain at an ADC of ≤650 × 10−6 m2/s was 100% specific and 68% sensitive for failure to wake up from coma before discharge. The ROC-AUC of ADC changes at ≤450 × 10−6 mm2/s and ≤650 × 10−6 mm2/s were significantly superior in predicting failure to wake up from coma compared to bilateral absence of pupillary reflexes. Among survivors, >0.01% of diffusion restriction of the entire brain at an ADC ≤450 × 10−6 m2/s was 100% specific and 46% sensitive for poor functional outcome at discharge. The ROC curve predicting poor functional outcome at ADC ≤450 × 10−6 mm2/s had an AUC of 0.737 (0.574–0.899, p = 0.04). Conclusion Post-anoxic diffusion changes using quantitative brain MRI may aid in predicting persistent coma and poor functional outcomes at hospital discharge." @default.
• W2626386101 created "2017-06-23" @default.
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• W2626386101 date "2017-08-01" @default.
• W2626386101 modified "2023-10-18" @default.
• W2626386101 title "Post-anoxic quantitative MRI changes may predict emergence from coma and functional outcomes at discharge" @default.
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• W2626386101 doi "https://doi.org/10.1016/j.resuscitation.2017.06.010" @default.
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