Clinical MRI interpretation for outcome prediction in cardiac arrest

David Greer, Patricia Scripko, James Bartscher, John Sims, Erica Camargo, Aneesh Singhal, Michael K. Parides, Karen Furie

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

Background In clinical practice, magnetic resonance imaging (MRI) is commonly used to assess the severity of a cardiac arrest patient's cerebral injury, utilizing treating neurologists' imaging interpretation. We sought to determine whether clinical interpretation of diffusion-weighted imaging (DWI) helps to determine poor outcome in comatose cardiac arrest patients. Methods We analyzed 80 consecutive MRIs from patients in coma following cardiac arrest. Each study was graded as "normal" or "abnormal restricted diffusion" in pre-specified brain regions by two blinded stroke neurologists. Poor outcome was defined as a modified Rankin Scale (mRS) score >4 at 3 months. Formal interpretations of neuroimaging by non-blinded neuroradiologists were compared with the blinded reviews by the stroke neurologists. Results DWI abnormalities were highly sensitive (98.5 %) but only modestly specific (46.2 %) for predicting poor neurological outcome. Inter-observer reliability was moderate (kappa = 0.49 ± 0.32), with 91 % agreement between study observers, and no significant differences in study observers' interpretations (p = 0.125). There were, however, significant differences between the study observers and the clinical neuroradiologists in identifying studies showing evidence of global hypoxic-ischemic injury (p = 0.001). Conclusions The qualitative evaluation of imaging abnormalities by stroke physicians in comatose cardiac arrest patients is a highly sensitive method of predicting poor outcome, but with limited specificity.

Original languageEnglish (US)
Pages (from-to)240-244
Number of pages5
JournalNeurocritical Care
Volume17
Issue number2
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Heart Arrest
Coma
Magnetic Resonance Imaging
Stroke
Wounds and Injuries
Neuroimaging
Physicians
Brain
Neurologists

Keywords

  • Cardiac arrest
  • Coma
  • Hypoxic-ischemic injury
  • MRI
  • Prognosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Greer, D., Scripko, P., Bartscher, J., Sims, J., Camargo, E., Singhal, A., ... Furie, K. (2012). Clinical MRI interpretation for outcome prediction in cardiac arrest. Neurocritical Care, 17(2), 240-244. https://doi.org/10.1007/s12028-012-9716-y

Clinical MRI interpretation for outcome prediction in cardiac arrest. / Greer, David; Scripko, Patricia; Bartscher, James; Sims, John; Camargo, Erica; Singhal, Aneesh; Parides, Michael K.; Furie, Karen.

In: Neurocritical Care, Vol. 17, No. 2, 01.10.2012, p. 240-244.

Research output: Contribution to journalReview article

Greer, D, Scripko, P, Bartscher, J, Sims, J, Camargo, E, Singhal, A, Parides, MK & Furie, K 2012, 'Clinical MRI interpretation for outcome prediction in cardiac arrest', Neurocritical Care, vol. 17, no. 2, pp. 240-244. https://doi.org/10.1007/s12028-012-9716-y
Greer D, Scripko P, Bartscher J, Sims J, Camargo E, Singhal A et al. Clinical MRI interpretation for outcome prediction in cardiac arrest. Neurocritical Care. 2012 Oct 1;17(2):240-244. https://doi.org/10.1007/s12028-012-9716-y
Greer, David ; Scripko, Patricia ; Bartscher, James ; Sims, John ; Camargo, Erica ; Singhal, Aneesh ; Parides, Michael K. ; Furie, Karen. / Clinical MRI interpretation for outcome prediction in cardiac arrest. In: Neurocritical Care. 2012 ; Vol. 17, No. 2. pp. 240-244.
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AB - Background In clinical practice, magnetic resonance imaging (MRI) is commonly used to assess the severity of a cardiac arrest patient's cerebral injury, utilizing treating neurologists' imaging interpretation. We sought to determine whether clinical interpretation of diffusion-weighted imaging (DWI) helps to determine poor outcome in comatose cardiac arrest patients. Methods We analyzed 80 consecutive MRIs from patients in coma following cardiac arrest. Each study was graded as "normal" or "abnormal restricted diffusion" in pre-specified brain regions by two blinded stroke neurologists. Poor outcome was defined as a modified Rankin Scale (mRS) score >4 at 3 months. Formal interpretations of neuroimaging by non-blinded neuroradiologists were compared with the blinded reviews by the stroke neurologists. Results DWI abnormalities were highly sensitive (98.5 %) but only modestly specific (46.2 %) for predicting poor neurological outcome. Inter-observer reliability was moderate (kappa = 0.49 ± 0.32), with 91 % agreement between study observers, and no significant differences in study observers' interpretations (p = 0.125). There were, however, significant differences between the study observers and the clinical neuroradiologists in identifying studies showing evidence of global hypoxic-ischemic injury (p = 0.001). Conclusions The qualitative evaluation of imaging abnormalities by stroke physicians in comatose cardiac arrest patients is a highly sensitive method of predicting poor outcome, but with limited specificity.

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