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Brain Diffusion Imaging Findings May Predict Clinical Outcome after Cardiac Arrest
Author(s) -
Oren Nisa Cem,
Chang Edwina,
Yang Carina WeiYee,
Lee SeonKyu
Publication year - 2019
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12626
Subject(s) - medicine , modified rankin scale , effective diffusion coefficient , diffusion mri , kappa , diffusion imaging , nuclear medicine , predictive value , radiology , magnetic resonance imaging , ischemic stroke , linguistics , philosophy , ischemia
BACKGROUND AND PURPOSE We aim to correlate the patterns of brain diffusion‐weighted imaging (DWI) and apparent diffusion coefficient (ADC) map in post cardiac arrest (PCA) patients with clinical outcomes. METHODS Thirty‐eight adult patients with PCA (mean age, 52.8 years; range 18–87 years) whose DWI obtained within 5 days of PCA were retrospectively reviewed. The visual DWI/ADC map categories include: Group 1: Normal; Group 2a: Mild [restricted diffusion (RD) < 1/3 cortical involvement (CI)]); Group 2b: Moderate (RD 1/3 > and < 2/3 CI); Group 2c: Severe (RD > 2/3 CI); and Group 3: Embolic (scattered, discrete foci of RD). Clinical outcomes were categorized according to cerebral performance categories (CPC) and modified Rankin scale (mRS). RESULTS The most common DWI/ADC map pattern was Group 1 (28.9%, n = 11). The incidence of other DWI patterns such as Group 2a, 2b, 2c, and 3 were 21% ( n = 8), 10.5% ( n = 4), 21% ( n = 8), and 18.4% ( n = 7), respectively. Twenty‐seven patients (71%) were CPC‐5/mRS‐6 and died or were category CPC‐4/mRS‐5, and 4 patients were CPC‐1/mRS 0–1 (10.5%). Interobserver agreement for visual classification of DWI/ADC map patterns was excellent (kappa = .8795). There was moderate positive correlation between clinical outcomes and visual DWI classification ( r = .461, P = .00358). The positive predictive value of this qualitative classification on DWI/ADC in predicting a poor clinical outcome (CPC‐4/mRS‐5 and CPC‐5/mRS‐6) was 81.4 % in the presence of restricted diffusion. CONCLUSION Simple visual categorization system using DWI/ADC map may be helpful and practical in estimating the clinical outcome of PCA patients.