Abstract 316: Ultra-early Diffusion-weighted Magnetic Resonance Imaging For Assessment Of Prognosis In Out-of-hospital Cardiac Arrest Survivors

Abstract

Aim: We investigated the association of poor neurological outcomes with ultra-early diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain in out-of-hospital cardiac arrest (OHCA) survivors and how to complement for false-negative findings (FNF). Methods: This registry-based observational study included adult comatose OHCA survivors who underwent DW-MRI scans within 6 h after the return of spontaneous circulation (ROSC). This study was divided into four groups: Group A (poor outcome with high-signal intensity (HSI) on DW-MRI), Group B (poor outcome without HSI [FNF]), Group C (good outcome without HSI), and Group D (good outcome with HSI). We analyzed serum and CSF neuron-specific enolase (NSE), albumin quotient (albumin CSF /albumin serum ) (Qa), apparent diffusion coefficient (ADC) value, and low flow time, among others, obtained within 6 h after ROSC. The primary outcome was the 3-month poor (CPC 3-5) outcome. Results: Of the 110 patients, 62 (56.4%) had poor outcomes, time from ROSC to MRI was 2.8 h (IQR, 2.0-4.0 h), and HSI on DW-MRI was observed in 46 (41.8%). The composition of Groups A, B, C, and D was 46 (41.8%), 16 (14.5%), 48 (43.6%), and 0 (0%) patients, respectively. Group B had significantly lower serum NSE, 650 ADC value, Qa, and low flow time than Group A; however, CSF NSE was higher than in Group C (Fig. 1). DW-MRI and CSF NSE identified patients with poor outcomes with 74.2% sensitivity (95% CI 61.5-84.5) and 100% specificity (95% CI 92.6-100), and 67.9% sensitivity (95% CI 53.7-80.1) and 100% specificity (95% CI 90.3-100), respectively. Combining the two tools increased identification to 87.1% sensitivity (95% CI 76.1-94.3) at 0% false positive rate (FPR). Conclusions: The HSI on ultra-early DW-MRI in OHCA survivors was significantly associated with poor outcomes. The CSF NSE is a complementary tool showing higher sensitivity at 0% FPR than DW-MRI alone. Multicenter prospective studies are required to determine the results’ generalizability.