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Published on: August 14, 2019
Regional brain injury on conventional and diffusion weighted MRI is associated with outcome after pediatric cardiac
Ericka L Fink1, A Panigrahy, R S B Clark
1Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15224, USA. finkel@ccm.upmc.edu
Insights
Pediatric cardiac arrest (CA) brain injury on MRI, particularly in the basal ganglia and brain lobes, predicts poor outcomes. Therapeutic hypothermia did not alter regional brain injury patterns in children post-cardiac arrest.
Area of Science:
- Neurology
- Radiology
- Pediatric Critical Care
Background:
- Pediatric cardiac arrest (CA) poses a significant risk of brain injury.
- Magnetic resonance imaging (MRI) is crucial for assessing this injury.
- Understanding regional brain injury patterns is key for neuroprotection and outcome prediction.
Purpose of the Study:
- To evaluate regional brain injury using MRI after pediatric CA.
- To correlate specific injury patterns with patient outcomes.
- To investigate the impact of therapeutic hypothermia on neuroprotection.
Main Methods:
- Retrospective chart review with prospective imaging analysis of pediatric CA patients.
- Brain MRI (1.5 T) analyzed by blinded neuroradiologists within 2 weeks of CA.
- Assessment of brain lobes, basal ganglia, thalamus, brain stem, and cerebellum using T1, T2, and diffusion-weighted imaging (DWI).
Main Results:
- Twenty-eight pediatric subjects (median age 1.9 years) were analyzed.
- Increased T2 signal in basal ganglia and restricted diffusion in brain lobes correlated with unfavorable outcomes (P < 0.05).
- Therapeutic hypothermia showed no significant effect on regional brain injury; lesion evolution was observed on repeat MRIs.
Conclusions:
- Basal ganglia lesions on conventional MRI and brain lobe lesions on DWI within 2 weeks post-CA indicate a high risk of poor outcome.
- These findings aid in developing targeted neuroprotective strategies.
- Regional injury patterns can inform the evaluation of therapeutic responses in clinical trials.
Background:
To assess regional brain injury on magnetic resonance imaging (MRI) after pediatric cardiac arrest (CA) and to associate regional injury with patient outcome and effects of hypothermia therapy for neuroprotection.
Methods:
We performed a retrospective chart review with prospective imaging analysis. Children between 1 week and 17 years of age who had a brain MRI in the first 2 weeks after CA without other acute brain injury between 2002 and 2008 were included. Brain MRI (1.5 T General Electric, Milwaukee, WI, USA) images were analyzed by 2 blinded neuroradiologists with adjudication; images were visually graded. Brain lobes, basal ganglia, thalamus, brain stem, and cerebellum were analyzed using T1, T2, and diffusion-weighted images (DWI).
Results:
We examined 28 subjects with median age 1.9 years (IQR 0.4-13.0) and 19 (68 %) males. Increased intensity on T2 in the basal ganglia and restricted diffusion in the brain lobes were associated with unfavorable outcome (all P < 0.05). Therapeutic hypothermia had no effect on regional brain injury. Repeat brain MRI was infrequently performed but demonstrated evolution of lesions.
Conclusion:
Children with lesions in the basal ganglia on conventional MRI and brain lobes on DWI within the first 2 weeks after CA represent a group with increased risk of poor outcome. These findings may be important for developing neuroprotective strategies based on regional brain injury and for evaluating response to therapy in interventional clinical trials.
