TY - JOUR
T1 - Free water corrected diffusion tensor imaging discriminates between good and poor outcomes of comatose patients after cardiac arrest
AU - Keijzer, Hanneke M.
AU - Duering, Marco
AU - Pasternak, Ofer
AU - Meijer, Frederick J.A.
AU - Verhulst, Marlous M.L.H.
AU - Tonino, Bart A.R.
AU - Blans, Michiel J.
AU - Hoedemaekers, Cornelia W.E.
AU - Klijn, Catharina J.M.
AU - Hofmeijer, Jeannette
N1 - Funding Information:
HMK is funded by the Rijnstate-Radboud promotion fund. OP is funded by two grants from the National Institute of Health (NIH) (grant numbers: NIH P41EB015902 and NIH R01MH074794). CJMK is supported by a clinically established investigator grant from the Dutch Heart Foundation (Grant Number 2012T077) and an ASPASIA grant from The Netherlands Organisation for Health Research and Development, ZonMw (grant number 015008048). JH is supported by a clinically established investigator grant from the Dutch Heart Foundation (Grant Number 2018T070)
Funding Information:
The authors thank Ruud van Kaam, a technical physician at the ICU of the Radboudumc, Yvonne Teitink and Helene Vogelensang, research nurses at the Rijnstate hospital, the staff of the ICU, radiology, and clinical neurophysiology departments, and technical medicine students for constructive assistance in obtaining informed consent and performing EEG measurements and MRI scans.
Publisher Copyright:
© 2022, The Author(s).
PY - 2023/3
Y1 - 2023/3
N2 - Objectives: Approximately 50% of comatose patients after cardiac arrest never regain consciousness. Cerebral ischaemia may lead to cytotoxic and/or vasogenic oedema, which can be detected by diffusion tensor imaging (DTI). Here, we evaluate the potential value of free water corrected mean diffusivity (MD) and fractional anisotropy (FA) based on DTI, for the prediction of neurological recovery of comatose patients after cardiac arrest. Methods: A total of 50 patients after cardiac arrest were included in this prospective cohort study in two Dutch hospitals. DTI was obtained 2–4 days after cardiac arrest. Outcome was assessed at 6 months, dichotomised as poor (cerebral performance category 3–5; n = 20) or good (n = 30) neurological outcome. We calculated the whole brain mean MD and FA and compared between patients with good and poor outcomes. In addition, we compared a preliminary prediction model based on clinical parameters with or without the addition of MD and FA. Results: We found significant differences between patients with good and poor outcome of mean MD (good: 726 [702–740] × 10-6 mm2/s vs. poor: 663 [575–736] × 10-6 mm2/s; p = 0.01) and mean FA (0.30 ± 0.03 vs. 0.28 ± 0.03; p = 0.03). An exploratory prediction model combining clinical parameters, MD and FA increased the sensitivity for reliable prediction of poor outcome from 60 to 85%, compared to the model containing clinical parameters only, but confidence intervals are overlapping. Conclusions: Free water-corrected MD and FA discriminate between patients with good and poor outcomes after cardiac arrest and hold the potential to add to multimodal outcome prediction. Key Points: • Whole brain mean MD and FA differ between patients with good and poor outcome after cardiac arrest. • Free water-corrected MD can better discriminate between patients with good and poor outcome than uncorrected MD. • A combination of free water-corrected MD (sensitive to grey matter abnormalities) and FA (sensitive to white matter abnormalities) holds potential to add to the prediction of outcome.
AB - Objectives: Approximately 50% of comatose patients after cardiac arrest never regain consciousness. Cerebral ischaemia may lead to cytotoxic and/or vasogenic oedema, which can be detected by diffusion tensor imaging (DTI). Here, we evaluate the potential value of free water corrected mean diffusivity (MD) and fractional anisotropy (FA) based on DTI, for the prediction of neurological recovery of comatose patients after cardiac arrest. Methods: A total of 50 patients after cardiac arrest were included in this prospective cohort study in two Dutch hospitals. DTI was obtained 2–4 days after cardiac arrest. Outcome was assessed at 6 months, dichotomised as poor (cerebral performance category 3–5; n = 20) or good (n = 30) neurological outcome. We calculated the whole brain mean MD and FA and compared between patients with good and poor outcomes. In addition, we compared a preliminary prediction model based on clinical parameters with or without the addition of MD and FA. Results: We found significant differences between patients with good and poor outcome of mean MD (good: 726 [702–740] × 10-6 mm2/s vs. poor: 663 [575–736] × 10-6 mm2/s; p = 0.01) and mean FA (0.30 ± 0.03 vs. 0.28 ± 0.03; p = 0.03). An exploratory prediction model combining clinical parameters, MD and FA increased the sensitivity for reliable prediction of poor outcome from 60 to 85%, compared to the model containing clinical parameters only, but confidence intervals are overlapping. Conclusions: Free water-corrected MD and FA discriminate between patients with good and poor outcomes after cardiac arrest and hold the potential to add to multimodal outcome prediction. Key Points: • Whole brain mean MD and FA differ between patients with good and poor outcome after cardiac arrest. • Free water-corrected MD can better discriminate between patients with good and poor outcome than uncorrected MD. • A combination of free water-corrected MD (sensitive to grey matter abnormalities) and FA (sensitive to white matter abnormalities) holds potential to add to the prediction of outcome.
KW - Brain edema
KW - Brain imaging
KW - Brain ischaemia
KW - Cardiac arrest
KW - MRI
UR - http://www.scopus.com/inward/record.url?scp=85142456899&partnerID=8YFLogxK
U2 - 10.1007/s00330-022-09245-w
DO - 10.1007/s00330-022-09245-w
M3 - Article
AN - SCOPUS:85142456899
SN - 0938-7994
VL - 33
SP - 2139
EP - 2148
JO - European radiology
JF - European radiology
ER -