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Association between ASL MRI-derived cerebral blood flow and outcomes after pediatric cardiac arrest
Matthew P Kirschen1, Minhui Ouyang2, Bhavesh Patel3
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Cerebral blood flow (CBF) measured by arterial spin labelling MRI after pediatric cardiac arrest is linked to patient outcomes. Higher CBF in the brain and specific regions correlates with poorer neurological status.
Area of Science:
- Neurology
- Pediatric Critical Care
- Medical Imaging
Background:
- Cerebral blood flow (CBF) regulation is often disrupted following cardiac arrest.
- The relationship between post-arrest CBF and neurological outcomes in children is not well understood.
Purpose of the Study:
- To investigate the association between CBF, measured using arterial spin labelling (ASL) MRI, and neurological outcomes in pediatric patients after cardiac arrest.
Main Methods:
- A retrospective observational study analyzed 48 pediatric patients (≤18 years) who underwent brain MRI within 7 days of cardiac arrest.
- Cerebral blood flow (CBF) was quantified using pulsed ASL in the whole brain and specific regions of interest.
- Neurological outcome was assessed using the Pediatric Cerebral Performance Category (PCPC), with unfavorable status defined as a change ≥1 and a discharge PCPC of 3-6.
Main Results:
- Patients with unfavorable neurological outcomes exhibited significantly higher whole-brain CBF (28.3 ml/100g/min) compared to those with favorable outcomes (19.6 ml/100g/min).
- This association between elevated CBF and unfavorable outcomes was consistent across individual brain regions.
- Logistic regression, controlling for age, sex, and time to MRI, revealed that higher CBF independently predicted unfavorable outcomes (aOR for whole brain 19.08).
Conclusions:
- Arterial spin labelling MRI can quantify cerebral blood flow (CBF) in pediatric cardiac arrest survivors.
- CBF measured 3-5 days post-arrest is an independent predictor of neurological outcome in children.
- Elevated CBF following pediatric cardiac arrest is associated with unfavorable neurological status.
Aim:
Cerebral blood flow (CBF) is dysregulated after cardiac arrest. It is unknown if post-arrest CBF is associated with outcome. We aimed to determine the association of CBF derived from arterial spin labelling (ASL) MRI with outcome after pediatric cardiac arrest.
Methods:
Retrospective observational study of patients ≤18 years who had a clinically obtained brain MRI within 7 days of cardiac arrest between June 2005 and December 2019. Primary outcome was unfavorable neurologic status: change in Pediatric Cerebral Performance Category (PCPC) ≥1 from pre-arrest that resulted in hospital discharge PCPC 3-6. We measured CBF in whole brain and regions of interest (ROIs) including frontal, parietal, and temporal cortex, caudate, putamen, thalamus, and brainstem using pulsed ASL. We compared CBF between outcome groups using Wilcoxon Rank-Sum and performed logistic regression to associate each region's CBF with outcome, accounting for age, sex, and time between arrest and MRI.
Results:
Forty-eight patients were analyzed (median age 2.8 [IQR 0.95, 8.8] years, 65% male). Sixty-nine percent had unfavorable outcome. Time from arrest to MRI was 4 [3,5] days and similar between outcome groups (p = 0.39). Whole brain median CBF was greater for unfavorable compared to favorable groups (28.3 [20.9,33.0] vs. 19.6 [15.3,23.1] ml/100 g/min, p = 0.007), as was CBF in individual ROIs. Greater CBF in the whole brain and individual ROIs was associated with higher odds of unfavorable outcome after controlling for age, sex, and days from arrest to MRI (aOR for whole brain 19.08 [95% CI 1.94, 187.41]).
Conclusion:
CBF measured 3-5 days after pediatric cardiac arrest by ASL MRI was independently associated with unfavorable outcome.
