Abstract
Aim
To analyze whether brain connectivity sequences including diffusion tensor imaging
(DTI) and resting state functional magnetic resonance imaging (rsfMRI) identify vulnerable
brain regions and networks associated with neurologic outcome after pediatric cardiac
arrest.
Methods
Children aged 2 d-17 y with cardiac arrest were enrolled in one of 2 parent studies
at a single center. Clinically indicated brain MRI with DTI and rsfMRI and performed
within 2 weeks after arrest were analyzed. Tract-wise fractional anisotropy (FA) and
axial, radial, and mean diffusivity assessed DTI, and functional connectivity strength
(FCS) assessed rsfMRI between outcome groups. Unfavorable neurologic outcome was defined
as Pediatric Cerebral Performance Category score 4–6 or change > 1 between 6 months
after arrest vs baseline.
Results
Among children with DTI (n = 28), 57% had unfavorable outcome. Mean, radial, axial
diffusivity and FA of varying direction of magnitude in the limbic tracts, including
the right cingulum parolfactory, left cingulum parahippocampal, corpus callosum forceps
major, and corpus callosum forceps minor tracts, were associated with unfavorable
neurologic outcome (p < 0.05). Among children with rsfMRI (n = 12), 67% had unfavorable
outcome. Decreased FCS in the ventromedial and dorsolateral prefrontal cortex, insula,
precentral gyrus, anterior cingulate, and inferior parietal lobule were correlated
regionally with unfavorable neurologic outcome (p < 0.05 Family-Wise Error corrected).
Conclusion
Decreased multimodal connectivity measures of paralimbic tracts were associated with
unfavorable neurologic outcome after pediatric cardiac arrest. Longitudinal analysis
correlating brain connectivity sequences with long term neuropsychological outcomes
to identify the impact of pediatric cardiac arrest in vulnerable brain networks over
time appears warranted.
Keywords
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Article info
Publication history
Published online: November 03, 2022
Accepted:
October 30,
2022
Received in revised form:
October 13,
2022
Received:
September 2,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
