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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
A practical magnetic-resonance imaging score for outcome prediction in comatose cardiac arrest survivors
Wang Pong Chan1, Christine Nguyen2, Noah Kim2
1Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Aim:
Magnetic Resonance Imaging (MRI) is an important prognostic tool in cardiac arrest (CA) survivors given its sensitivity for detecting hypoxic-ischemic brain injury (HIBI), however, it is limited by poorly defined objective thresholds. To address this limitation, we evaluated a qualitative MRI score for predicting neurological outcome in CA survivors.
Methods:
Adult comatose CA survivors who underwent MRI were retrospectively identified at a single academic medical center. Two blinded neurointensivists qualitatively scored HIBI amongst 12 MRI brain regions. Scores were summated to form four distinct score groups: cortex, deep grey nuclei (DGN), cortex-DGN combined, and total (cortex, DGN, brainstem, and cerebellum). Poor neurological outcome was defined as Cerebral Performance Category (CPC) score 3-5 at hospital discharge. Inter-rater reliability was tested using intra-class correlation (ICC) and discrimination of poor neurological outcome assessed using area under the receiver operating curve (AUC).
Results:
Our cohort included 219 patients with median time to MRI of 96 (IQR 81-110) hours. ICC (95% CI) was good to excellent across all MRI scores: cortex 0.92 (0.89-0.94), DGN 0.88 (0.80-0.92), cortex-DGN 0.94 (0.92-0.95), and total 0.93 (0.91-0.95). AUC (95% CI) for poor outcome was good across all MRI scores: cortex 0.84 (0.78-0.90), DGN 0.83 (0.77-0.89), cortex-DGN 0.83 (0.77-0.89), and total 0.83 (0.77-0.88).
Conclusion:
A simplified, qualitative MRI score had excellent reliability and good discrimination for poor neurologic outcome. Further work is necessary to externally validate our findings in an independent, ideally prospective, cohort.
Insights
A new qualitative MRI scoring system reliably predicts neurological outcomes in cardiac arrest survivors with hypoxic-ischemic brain injury. This method offers a valuable prognostic tool for assessing brain injury severity and guiding patient care.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Magnetic Resonance Imaging (MRI) is crucial for prognostication in cardiac arrest (CA) survivors, detecting hypoxic-ischemic brain injury (HIBI).
- Current MRI methods for HIBI lack objective thresholds, limiting their prognostic accuracy.
- There is a need for reliable, objective MRI-based tools to predict neurological outcomes in CA survivors.
Purpose of the Study:
- To evaluate a novel qualitative MRI scoring system for predicting neurological outcomes in adult comatose cardiac arrest survivors.
- To assess the reliability and discriminative ability of this MRI score in identifying patients with poor neurological outcomes.
Main Methods:
- Retrospective analysis of adult comatose CA survivors who underwent MRI at a single academic center.
- Two neurointensivists qualitatively scored HIBI across 12 brain regions, summing scores into four distinct groups (cortex, deep grey nuclei, cortex-DGN, total).
- Neurological outcome was defined by Cerebral Performance Category (CPC) scores 3-5; inter-rater reliability (ICC) and outcome discrimination (AUC) were calculated.
Main Results:
- The study included 219 patients with a median MRI time of 96 hours post-CA.
- All MRI score groups demonstrated good to excellent inter-rater reliability (ICC range: 0.88-0.94).
- The MRI scores showed good discrimination for poor neurological outcome (AUC range: 0.83-0.84).
Conclusions:
- A simplified, qualitative MRI scoring system exhibits excellent reliability and good discriminative performance for predicting poor neurological outcomes in CA survivors.
- This scoring system can serve as a valuable prognostic tool in clinical practice.
- External validation in a prospective cohort is recommended to confirm these findings.
