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Background <p>Brain magnetic resonance imaging (MRI) has been investigated as a neuroprognostication (NP) test after out-of-hospital cardiac arrest (OHCA); however, most studies have focused on predicting poor neurologic outcomes or death.</p> Methods <p>We examined the ability of a composite brain MRI score (“NP score”) to predict neurologic outcomes in an OHCA cohort (2017–2023) who underwent brain MRI within 2–7&#xa0;days post arrest and survived to hospital discharge. NP scores (range 0–214) were calculated from diffusion weighted imaging and fluid attenuated inversion recovery signals in prespecified neuroanatomical regions. We categorized neurologic outcomes as “independent” (Cerebral Performance Categories [CPC] 1–2), “dependent” (CPC 3), and “vegetative state” (CPC 4). We conducted correlation analyses and used computational modeling for probabilities to identify transition points between the outcome categories.</p> Results <p>Forty-two OHCA survivors were included (median age 47&#xa0;years; 74% male, 43% shockable rhythm; 88% underwent targeted temperature management). At hospital discharge, 50% (<i>n</i> = 21) had recovered to independent, 24% (<i>n</i> = 10) were dependent, and 26% (<i>n</i> = 11) remained in a vegetative state. MRIs were obtained at a median of 4&#xa0;days post arrest, (interquartile range 3–5). NP scores (range 0–136, median 11.5, interquartile range 0–41.5, intraclass correlation coefficient 0.89) strongly correlated with CPC (<i>r</i><sub><i>s</i></sub> = 0.69, <i>p</i> &lt; 0.001) and were significantly different between CPC groups (<i>p</i> &lt; 0.001); thresholds of 15 and 54 were identified as transition points between independent–dependent and dependent–vegetative state, respectively. Among survivors with bilaterally intact somatosensory evoked potentials, median NP scores were 0, 29, 68.5 for independent, dependent, and vegetative state patients, respectively.</p> Conclusions <p>Quantitative brain MRI-based scoring may predict neurologic outcomes at discharge among OHCA survivors. External validation in larger prospective multicenter cohorts, assessment of long-term outcomes, and examination of the score in deceased patients are needed to establish the prognostic value and address concerns about generalizability.</p>

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Ability of a Composite Brain Magnetic Resonance Imaging Score to Predict Neurologic Outcomes in Survivors of Out-Of-Hospital Cardiac Arrest

  • 期刊论文

  • 发表日期：

    2025年6月19日

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  • Thuhien Nguyen,
  • Nicolas Poilvert,
  • Victor Lin,
  • Hope Opara,
  • Nassim Matin,
  • Arielle P. Davis,
  • Breana L. Taylor,
  • Catherine R. Counts,
  • Penelope Chung Thomas,
  • Monisha Sharma,
  • James A. Town,
  • Sarah Wahlster,
  • Nicholas J. Johnson

摘要

Background

Brain magnetic resonance imaging (MRI) has been investigated as a neuroprognostication (NP) test after out-of-hospital cardiac arrest (OHCA); however, most studies have focused on predicting poor neurologic outcomes or death.

Methods

We examined the ability of a composite brain MRI score (“NP score”) to predict neurologic outcomes in an OHCA cohort (2017–2023) who underwent brain MRI within 2–7 days post arrest and survived to hospital discharge. NP scores (range 0–214) were calculated from diffusion weighted imaging and fluid attenuated inversion recovery signals in prespecified neuroanatomical regions. We categorized neurologic outcomes as “independent” (Cerebral Performance Categories [CPC] 1–2), “dependent” (CPC 3), and “vegetative state” (CPC 4). We conducted correlation analyses and used computational modeling for probabilities to identify transition points between the outcome categories.

Results

Forty-two OHCA survivors were included (median age 47 years; 74% male, 43% shockable rhythm; 88% underwent targeted temperature management). At hospital discharge, 50% (n = 21) had recovered to independent, 24% (n = 10) were dependent, and 26% (n = 11) remained in a vegetative state. MRIs were obtained at a median of 4 days post arrest, (interquartile range 3–5). NP scores (range 0–136, median 11.5, interquartile range 0–41.5, intraclass correlation coefficient 0.89) strongly correlated with CPC (rs = 0.69, p < 0.001) and were significantly different between CPC groups (p < 0.001); thresholds of 15 and 54 were identified as transition points between independent–dependent and dependent–vegetative state, respectively. Among survivors with bilaterally intact somatosensory evoked potentials, median NP scores were 0, 29, 68.5 for independent, dependent, and vegetative state patients, respectively.

Conclusions

Quantitative brain MRI-based scoring may predict neurologic outcomes at discharge among OHCA survivors. External validation in larger prospective multicenter cohorts, assessment of long-term outcomes, and examination of the score in deceased patients are needed to establish the prognostic value and address concerns about generalizability.