The Usefulness of Quantitative Analysis of Blood-Brain Barrier Disruption Measured Using Contrast-Enhanced Magnetic Resonance Imaging to Predict Neurological Prognosis in Out-of-Hospital Cardiac Arrest Survivors: A Preliminary Study.

Ho Il Kim,Da Mi Kim,Yong Chul Cho,In Ho Lee,Jin Hong Min,Yeonho You,Won Joon Jeong,Hong Joon Ahn,Byung Kook Lee,Jung Soo Park,Changshin Kang

doi:10.3390/jcm9093013

Abstract

We aimed to evaluate neurological outcomes associated with blood-brain barrier (BBB) disruption using contrast-enhanced magnetic resonance imaging (CE-MRI) in out-of-hospital cardiac arrest (OHCA) survivors. This retrospective observational study involved OHCA survivors who had undergone CE-MRI for prognostication. Qualitative and quantitative analyses were performed using the presence of BBB disruption (pBD) and the BBB disruption score (sBD) in CE-MRI scans, respectively. For the sBD, 1 point was assigned for each area of BBB disruption, and 6 points were assigned when an absence of intracranial blood flow due to severe brain oedema was confirmed. The primary outcome was poor neurological outcome at 3 months (defined as cerebral performance categories 3–5). We analysed 46 CE-MRI brain scans (27 patients). Of these, 15 (55.6%) patients had poor neurological outcomes. Poor neurological outcome group patients showed a significantly higher proportion of pBD than those in the good neurological outcome group (22 (88%) vs. 6 (28.6%) patients, respectively, p < 0.001) and a higher sBD (5.0 (4.0–5.0) vs. 0.0 (0.0–1.0) patients, p < 0.001). Poor neurological outcome predictions showed that the sBD had a significantly better prognostic performance (area under the curve (AUC) 0.95, 95% confidence interval (CI) 0.84–0.99) than the pBD (AUC 0.80, 95% CI 0.65–0.90). The sBD cut-off value was >1 point (sensitivity, 96.0%; specificity, 81.0%). The sBD is a highly predictive and sensitive marker of 3-month poor neurological outcome in OHCA survivors. Multicentre prospective studies are required to determine the generalisability of these results.

Highlights

Cardiac arrest (CA) is a common cause of death and disability [1]
Our previous study is the first clinical study wherein we report that severe blood-brain barrier (BBB) disruption onset timing and severe BBB disruption are strongly associated with poor neurological outcomes; we did not observe a relationship between neurological outcome and the degree of BBB disruption [9]
The first brain magnetic resonance imaging (MRI) scans were obtained at a median of 2.6 (1.9–3.9) h after return of spontaneous circulation (ROSC) and the second brain MRI scans were acquired at a median of 76.7 (75.2–76.7) h after ROSC

Summary

Introduction

Cardiac arrest (CA) is a common cause of death and disability [1]. Among more than 300,000 CA events that occur each year in the United States, the rate of survival to hospital discharge from out-of-hospital cardiac arrest (OHCA) has been reported to be

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