Aims and objectives
Clinical guidelines recommend the use of brain magnetic resonance imaging for neurological prognostication of patients that remain comatose 2 or more days after an out of hospital cardiac arrest (OHCA) [1].
The prognostic accuracy of magnetic resonance imaging at the early phase after OHCA has not been established.
The aim of this study was to evaluate the predictive accuracy of diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1H-MRS) within 72 hours for mortality at 6-months in comatose survivors of OHCA.
Methods and materials
Study design and participants
This study was a randomised single-blinded phase 2 clinical drug trial (part of the Xe-HYPOTHECA trial) at two multipurpose intensive care units in Finland (ClinicalTrials.gov,
number NCT00879892).
The study was approved by the ethics committee of the Hospital District of Southwest Finland and the institutional review boards of the Helsinki University Hospital and the Finnish Medicines Agency.
All patients’ next of kin or legal representative gave written informed assent within 4 hours after hospital arrival.
Consent was sought from patients if...
Results
Patients
Of the randomised patients 93 had both DTI and 1H-MRS data available.
The brain imaging was performed in a median (inter-quartile range) time of 53 hours (47-64) after OHCA.
During the follow-up of six-months 27 patients (28%) died.
DTI and 1H-MRS results
Global fractional anisotropy values of the DTI,
and tNAA/tCr and tNAA/tCho ratios of the 1H-MRS were significantly higher in the survivors and in patients with good neurological outcome than in the non-survivors and in patients with poor neurological outcome.
Other DTI and...
Conclusion
The combined predictive accuracy of global fractional anisotropy and tNAA/tCr of 1H-MRS within 72 hours after OHCA was good for mortality at six months after OHCA and could be used in clinical prognostication in conjunction with other methods.
This evidence warrants validation in another population of OHCA patients with similar imaging windows.
Personal information
K.
Koskensalo,
M.Sc
Department of Medical Physics,
Turku University Hospital,
Turku,
Finland.
Kiinamyllynkatu 4 - 8
20520Turku,
Finland
email:
[email protected]
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