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Early diffusion-weighted magnetic resonance imaging in children after cardiac arrest may provide valuable prognostic information on clinical outcome

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Abstract

Objective

We examined whether early diffusion-weighted magnetic resonance imaging (DW-MRI) abnormalities of the brain and variation of apparent diffusion coefficient (ADC) values can provide prognostic information on clinical outcome in children following cardiac arrest (CA).

Design

Retrospective study.

Setting

A 12-bed paediatric intensive care unit (PICU).

Patients

Children aged between 1 month and 18 years who had DW-MRI with ADC measurement within the first week following CA. Neurological outcomes were assessed using the Pediatric Cerebral Performance Category Scale (PCPC). Differences between the favourable (PCPC ≤3) and unfavourable (PCPC ≥4) groups were analysed with regard to clinical data, electrophysiological patterns as well as qualitative and quantitative DW-MRI abnormalities.

Results

Twenty children with a median age of 20 months (1.5–185) and a male/female sex ratio of 1.5 underwent DW-MRI after CA with a median delay of 3 days (1–7). Aetiologies of CA were (i) asphyxia (n = 10), (ii) haemodynamic (n = 5) or (iii) unknown (n = 5). With regard to DW-MRI findings, the unfavourable outcome group (n = 8) was associated with cerebral cortex (p = 0.02) and basal ganglia (p = 0.005) lesions, with a larger number of injured brain regions (p = 0.001) and a global decrease in measured ADC signal (p = 0.008). Normal DW-MRI (n = 5) was exclusively associated with the favourable outcome group (n = 12).

Conclusion

Qualitative, topographic and quantitative analysis of early DW-MRI with ADC measurement in children following CA may provide valuable prognostic information on neurological outcomes.

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Authors and Affiliations

  1. Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743, Paris Cedex 15, France

    Mehdi Oualha, Pauline Gatterre, Laurent Dupic, Laure De Saint Blanquat, Philippe Hubert & Fabrice Lesage

  2. Service de Radiologie Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743, Paris Cedex 15, France

    Nathalie Boddaert

  3. Service de Neurologie Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743, Paris Cedex 15, France

    Isabelle Desguerre

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  1. Mehdi Oualha
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Correspondence to Mehdi Oualha.

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Oualha, M., Gatterre, P., Boddaert, N. et al. Early diffusion-weighted magnetic resonance imaging in children after cardiac arrest may provide valuable prognostic information on clinical outcome. Intensive Care Med 39, 1306–1312 (2013). https://doi.org/10.1007/s00134-013-2930-z

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  • DOI: https://doi.org/10.1007/s00134-013-2930-z

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