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Diffusion tensor imaging to predict long-term outcome after cardiac arrest: a bicentric pilot study.

Abstract : BACKGROUND: Prognostication in comatose survivors of cardiac arrest is a major clinical challenge. The authors' objective was to determine whether an assessment with diffusion tensor imaging, a brain magnetic resonance imaging sequence, increases the accuracy of 1 yr functional outcome prediction in cardiac arrest survivors. METHODS: Prospective, observational study in two intensive care units. Fifty-seven comatose survivors of cardiac arrest underwent brain magnetic resonance imaging. Fractional anisotropy (FA), a diffusion tensor imaging value, was measured in predefined white matter regions, and apparent diffusion coefficient was assessed in predefined grey matter regions. Prediction of unfavorable outcome at 1 yr was compared using four prognostic models: FA global, FA selected, apparent diffusion coefficient, and clinical classifiers. RESULTS: Of the 57 patients included in the study, 49 had an unfavorable outcome at 12 months. Areas under the receiver operating characteristic curve (95% CI) to predict unfavorable outcome for the FA global, FA selected, clinical, and apparent diffusion coefficient models were 0.92 (0.82-0.98), 0.96 (0.87-0.99), 0.78 (0.65-0.88), and 0.86 (0.74-0.94), respectively. The FA selected model had the best overall accuracy for predicting outcome, with a score above 0.44 having 94% (95% CI, 83-99%) sensitivity and 100% (95% CI, 63-100%) specificity for the prediction of unfavorable outcome. CONCLUSION: Quantitative diffusion tensor imaging indicates that white matter damage is widespread after cardiac arrest. A prognostic model based on FA values in selected white matter tracts seems to predict accurately 1 yr functional outcome. These preliminary results need to be confirmed in a larger population.
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Contributor : Olivier Colliot Connect in order to contact the contributor
Submitted on : Wednesday, April 24, 2013 - 7:50:30 PM
Last modification on : Wednesday, November 9, 2022 - 1:42:09 PM

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Charles-Edouard Luyt, Damien Galanaud, Vincent Perlbarg, Audrey Vanhaudenhuyse, Robert D Stevens, et al.. Diffusion tensor imaging to predict long-term outcome after cardiac arrest: a bicentric pilot study.. Anesthesiology, 2012, 117 (6), pp.1311-21. ⟨10.1097/ALN.0b013e318275148c⟩. ⟨hal-00817572⟩



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