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Qualitative and quantitative analysis of diffusion-weighted brain MR imaging in comatose survivors after cardiac arrest

  • Diagnostic Neuroradiology
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Abstract

Purpose

The aim of this study is to compare a qualitative and a quantitative assessment of brain diffusion-weighted imaging (DWI) in predicting outcome of comatose patients after cardiac arrest (CA).

Methods

Two observers used a scoring template to analyze the DWI of 75 patients. A total of 13 regions were scored from 0 to 3 (0 = normal, 1 = probably normal, 2 = probably abnormal, 3 = definitely abnormal). The total cerebral cortex (TCC), the total deep grey nuclei (TDGN), the total brain stem, the total cerebellum, and the total brain score were calculated. Intra- and inter-observer variability were tested. The mean whole brain apparent diffusion coefficient (ADC) values and percentage of voxels below a specific ADC value cut-off were calculated. The data were correlated with clinical outcome (cerebral performance category score after 180 days, dichotomized in a score 1–2 with favorable outcome and score 3–5 with unfavorable outcome) using ROC analysis.

Results

Intra-observer variability was excellent for the TCC score (ICC 0.95 and 0.86) and the TDGN score (ICC 0.89 and 0.75). Inter-observer variability was good to excellent for total cerebral cortex score and total deep grey nuclei score in both the first (ICC 0.78 and 0.69) and third (ICC 0.86 and 0.83) image assessment. TCC and TDGN score show the best correlation with clinical outcome (highest AUC values 0.87 and 0.87). Quantitative parameters did not show good correlation with clinical outcome (AUC values 0.57 and 0.60).

Conclusion

A qualitative assessment of brain DWI using a scoring template provides useful data regarding patient outcome while quantitative data appeared less reliable.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

CA:

Cardiac arrest

CPC:

Cerebral performance category

DWI:

Diffusion-weighted imaging

FLAIR:

Fluid-attenuated inversion recovery

ICC:

Intra-class correlation coefficient

MWB:

Mean whole brain

PV650:

Percentage of voxels with an ADC value of less than 0.650 × 10−3 mm2/s

ROC:

Receiver operator curve

RS:

Spearman’s rank correlation

TB:

Total brain

TBS:

Total brainstem

TC:

Total cerebellum

TCC:

Total cerebral cortex

TDGN:

Total deep grey nuclei

WML:

White matter lesions

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Simon Vanden Berghe, Sarah Cappelle, Frederik De Keyzer, Ron Peeters, Kristof Coursier, Sofie Van Cauter & Philippe Demaerel

  2. Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium

    Kristof Coursier & Sofie Van Cauter

  3. Faculty of Medicine, KU Leuven, Leuven, Belgium

    Arno Depotter

  4. Department of Cardiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Koen Ameloot & Stefan Janssens

  5. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium

    Koen Ameloot & Jo Dens

  6. Department of Neurology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Robin Lemmens

Authors
  1. Simon Vanden Berghe
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  2. Sarah Cappelle
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  3. Frederik De Keyzer
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  4. Ron Peeters
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  5. Kristof Coursier
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  7. Sofie Van Cauter
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  8. Koen Ameloot
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  9. Jo Dens
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  10. Robin Lemmens
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  11. Stefan Janssens
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Corresponding author

Correspondence to Philippe Demaerel.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sarah Cappelle is joint first author of the paper.

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Vanden Berghe, S., Cappelle, S., De Keyzer, F. et al. Qualitative and quantitative analysis of diffusion-weighted brain MR imaging in comatose survivors after cardiac arrest. Neuroradiology 62, 1361–1369 (2020). https://doi.org/10.1007/s00234-020-02460-6

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  • DOI: https://doi.org/10.1007/s00234-020-02460-6

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