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

Abstract

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). Retrospective study. A 12-bed paediatric intensive care unit (PICU). Children aged between 1month and 18years 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. Twenty children with a median age of 20months (1.5-185) and a male/female sex ratio of 1.5 underwent DW-MRI after CA with a median delay of 3days (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). Qualitative, topographic and quantitative analysis of early DW-MRI with ADC measurement in children following CA may provide valuable prognostic information on neurological outcomes.