Brain MR imaging and spectroscopy for outcome prognostication after pediatric cardiac arrest

RESUSCITATION

卷:157

Article

FInk, Ericka L.^1,3,8  Wisnowski, Jessica¹⁰  Clark, Robert^1,3,8  Berger, Rachel P.^1,8  Fabio, Anthony²  Furtado, Andre⁶  Narayan, Srikala⁶  Angus, Derek C.^3,9  Watson, R. Scott^4,5  Wang, Chunyan²  Callaway, Clifton W.^7,8  Bell, Michael J.¹¹  Kochanek, Patrick M.^1,3,8  Bluml, Stefan¹⁰  Panigrahy, Ashok^1,6 

[1] UPMC Childrens Hosp Pittsburgh, Dept Pediat, Pittsburgh, PA USA

[2] Univ Pittsburgh, Dept Epidemiol, Sch Med, Pittsburgh, PA 15261 USA

[3] Univ Pittsburgh, Med Ctr, Dept Crit Care Med, Pittsburgh, PA USA

[4] Univ Washington, Sch Med, Dept Pediat, Seattle, WA 98195 USA

[5] Seattle Childrens Res Inst, Ctr Child Hlth Behav & Dev, Seattle, WA USA

[6] UPMC Childrens Hosp Pittsburgh, Dept Radiol, Pittsburgh, PA USA

[7] Univ Pittsburgh, Med Ctr, Emergency Med, Pittsburgh, PA USA

[8] Safar Ctr Resuscitat Res, Pittsburgh, PA USA

[9] Clin Res Invest & Syst Modeling Acute Illness CRI, Pittsburgh, PA USA

[10] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA

[11] Childrens Natl Med Ctr, Washington, DC 20010 USA

关键词: Pediatric;    Cardiac arrest;    Prognostication;    Magnetic resonance imaging;    Outcome;    Magnetic resonance spectroscopy;   

DOI  :  10.1016/j.resuscitation.2020.06.033

来源: Elsevier

【 摘 要 】

Aim: Children surviving cardiac arrest are at high risk of neurological morbidity and mortality; however, there is a lack of validated prognostic biomarkers. We aimed to evaluate brain magnetic resonance imaging (MRI) and spectroscopy (MRS) as predictors of death and disability. Secondly, we evaluated whether MRI/S by randomized group. Methods: This single center study analyzed clinically indicated brain MRI/S data from children enrolled in a randomized controlled trial of 24 vs. 72 h of hypothermia following cardiac arrest. Two pediatric radiologists scored conventional MRIs. Lactate and N-acetyl-aspartate (NAA) concentrations (mmol/kg) were determined from spectra acquired from the basal ganglia, thalamus, parietal white matter and parietooccipital gray matter. Mortality and neurological outcomes (favorable = Pediatric Cerebral Performance Category [PCPC] 1, 2, 3 or increase <2) were assessed at hospital discharge. Nonparametric tests were used to test for associations between MRI/S biomarkers and outcome and randomized group. Results: 23 children with (median [interquartile range]) age of 1.5 (0.3-4.0) years. Ten (44%) had favorable outcome. There were more T2 brain lesions in the lentiform nuclei in children with unfavorable 12 (92%) vs. favorable 3 (33%) outcome, p= 0.007. Increased lactate and decreased NAA concentrations in the parietooccipital gray matter and decreased NAA in the parietal white matter were associated with unfavorable outcome (p's < 0.05). There were no differences for any biomarker by randomized group. Conclusion: Regional cerebral and metabolic MRI/S biomarkers are predictive of neurological outcomes at hospital discharge in pediatric cardiac arrest and should undergo validation testing in a large sample.

【 授权许可】

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