Qualitative and quantitative analysis of diffusion-weighted brain MR imaging in comatose survivors after cardiac arrest
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DIAGNOSTIC NEURORADIOLOGY
Qualitative and quantitative analysis of diffusion-weighted brain MR imaging in comatose survivors after cardiac arrest Simon Vanden Berghe 1 & Sarah Cappelle 1 & Frederik De Keyzer 1 & Ron Peeters 1 & Kristof Coursier 1,2 & Arno Depotter 3 & Sofie Van Cauter 1,2 & Koen Ameloot 4,5 & Jo Dens 5 & Robin Lemmens 6 & Stefan Janssens 4 & Philippe Demaerel 1 Received: 2 April 2020 / Accepted: 13 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of this study is to compare a qualitative and a quantitative assessment of brain diffusion-weighted imaging (DWI) in predicting outcome of comatose patients after cardiac arrest (CA). Methods Two observers used a scoring template to analyze the DWI of 75 patients. A total of 13 regions were scored from 0 to 3 (0 = normal, 1 = probably normal, 2 = probably abnormal, 3 = definitely abnormal). The total cerebral cortex (TCC), the total deep grey nuclei (TDGN), the total brain stem, the total cerebellum, and the total brain score were calculated. Intra- and interobserver variability were tested. The mean whole brain apparent diffusion coefficient (ADC) values and percentage of voxels below a specific ADC value cut-off were calculated. The data were correlated with clinical outcome (cerebral performance category score after 180 days, dichotomized in a score 1–2 with favorable outcome and score 3–5 with unfavorable outcome) using ROC analysis. Results Intra-observer variability was excellent for the TCC score (ICC 0.95 and 0.86) and the TDGN score (ICC 0.89 and 0.75). Inter-observer variability was good to excellent for total cerebral cortex score and total deep grey nuclei score in both the first (ICC 0.78 and 0.69) and third (ICC 0.86 and 0.83) image assessment. TCC and TDGN score show the best correlation with clinical outcome (highest AUC values 0.87 and 0.87). Quantitative parameters did not show good correlation with clinical outcome (AUC values 0.57 and 0.60). Conclusion A qualitative assessment of brain DWI using a scoring template provides useful data regarding patient outcome while quantitative data appeared less reliable. Keywords Heart arrest . Brain . Ischemia . Cerebral cortex . Diffusion magnetic resonance imaging
Introduction Sarah Cappelle is joint first author of the paper. * Philippe Demaerel [email protected] 1
Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
2
Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
3
Faculty of Medicine, KU Leuven, Leuven, Belgium
4
Department of Cardiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
5
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
6
Department of Neurology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
Cardiac arrest (CA) is frequent in the western population regarding the high prevalence of cardiovascular disease [1]. There is a significant mortality for comatose CA patients and survivors may have severe disabilities after long periods of
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