한빛사논문
Jung A. Yoon1†, Changshin Kang1,2†, Jung Soo Park1,2*, Yeonho You1,2, Jin Hong Min2,3, Yong Nam In2,3, Wonjoon Jeong1,2, Hong Joon Ahn1,2, In Ho Lee4, Hye Seon Jeong5, Byung Kook Lee6 and Jae Kwang Lee7
1Department of Emergency Medicine, Chungnam National University Hospital, Daejoen, Republic of Korea.
2Department of Emergency Medicine, College of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon 35015, Republic of Korea.
3Department of Emergency Medicine, Sejong Chungnam National University Hospital, Daejoen, Republic of Korea.
4Department of Radiology, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
5Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea.
6Department of Emergency Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
7Department of Emergency Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea.
†Jung A. Yoon and Changshin Kang contributed equally to this work.
*Correspondence: Jung Soo Park
Abstract
Background: This study aimed to quantitatively analyse ultra-early brain diffusion-weighted magnetic resonance imaging (DW-MRI) findings to determine the apparent diffusion coefficient (ADC) threshold associated with neurological outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA).
Methods: This retrospective study included adult survivors of comatose OHCA who underwent DW-MRI imaging scans using a 3-T MRI scanner within 6 h of the return of spontaneous circulation (ROSC). We investigated the association between neurological outcomes and ADC values obtained through voxel-based analysis on DW-MRI. Additionally, we constructed multivariable logistic regression models with pupillary light reflex (PLR), serum neuron-specific enolase (NSE), and ADC values as independent variables to predict poor neurological outcomes. The primary outcome was poor neurological outcome 6 months after ROSC, determined by the Cerebral Performance Category 3-5.
Results: Overall, 131 patients (26% female) were analysed, of whom 74 (57%) showed poor neurological outcomes. The group with a poor neurological outcome had lower mean whole brain ADC values (739.1 vs. 787.1 × 10-6 mm/s) and higher percentages of voxels with ADC below threshold in all ranges (250-1150) (all P < 0.001). The mean whole brain ADC values (area under the receiver operating characteristic curve [AUC] 0.83) and the percentage of voxels with ADC below 600 (AUC 0.81) had the highest sensitivity of 51% (95% confidence interval [CI] 39.4-63.1; cut-off value ≤ 739.2 × 10-6 mm2/s and > 17.2%, respectively) when the false positive rate (FPR) was 0%. In the multivariable model, which also included PLR, NSE, and mean whole brain ADC values, poor neurological outcome was predicted with the highest accuracy (AUC 0.91; 51% sensitivity). This model showed more accurate prediction and sensitivity at an FPR of 0% than did the combination of PLR and NSE (AUC 0.86; 30% sensitivity; P = 0.03).
Conclusions: In this cohort study, early voxel-based quantitative ADC analysis after ROSC was associated with poor neurological outcomes 6 months after cardiac arrest. The mean whole brain ADC value demonstrated the highest sensitivity when the FPR was 0%, and including it in the multivariable model improved the prediction of poor neurological outcomes.
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