Abstract
Background
This study evaluated the association between the extent of diffusion restriction on
brain diffusion-weighted imaging (DWI) and neurological outcomes in patients who underwent
targeted temperature management (TTM) after an out-of-hospital cardiac arrest (OHCA).
Methods
Patients who underwent brain magnetic resonance imaging within 10 days of OHCA between
2012 and 2021 were analysed. The extent of diffusion restriction was described according
to the modified DWI Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS).
The 35 predefined brain regions were assigned a score if diffuse signal changes were
concordantly present in DWI scans and apparent diffusion coefficient maps. The primary
outcome was an unfavourable neurological outcome at 6 months. The sensitivity, specificity,
and receiver operating characteristic (ROC) curves for the measured parameters were
analysed. Cut-off values were determined to predict the primary outcome. The predictive
cut-off DWI-ASPECTS was internally validated using five-fold cross-validation.
Results
Of the 301 patients, 108 (35.9%) had 6-month favourable neurological outcomes. Patients
with unfavourable outcomes had higher whole-brain DWI-ASPECTS (median, 31 [26–33]
vs. 0 [0–1], P < 0.001) than those with favourable outcomes. The area under the ROC curve (AUROC)
of whole-brain DWI-ASPECTS was 0.957 (95% confidence interval [CI] 0.928–0.977). A
cut-off value of ≥8 for unfavourable neurological outcomes had specificity and sensitivity
of 100% (95% CI 96.6–100) and 89.6% (95% CI 84.4–93.6), respectively. The mean AUROC
was 0.956.
Conclusion
More extensive diffusion restriction on DWI-ASPECTS in patients with OHCA who underwent
TTM was associated with 6-month unfavourable neurological outcomes.
Running title: Diffusion restriction and neurological outcomes after cardiac arrest.
Keywords
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Article info
Publication history
Published online: March 08, 2023
Accepted:
March 1,
2023
Received in revised form:
February 16,
2023
Received:
January 6,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
