Global and Regional Derangements of Cerebral Blood Flow and Diffusion Magnetic Resonance Imaging after Pediatric Cardiac Arrest

Objective To quantify and examine the relationship between global and regional cerebral blood flow (CBF) and water diffusion on brain magnetic resonance imaging (MRI) in children after cardiac arrest. Study design Children admitted to a tertiary care children's hospital from July 2011 to April...

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Bibliographic Details
Published in:The Journal of pediatrics 2016-02, Vol.169, p.28-35.e1
Main Authors: Manchester, Leah C., BA, Lee, Vince, MD, Schmithorst, Vincent, PhD, Kochanek, Patrick M., MD, Panigrahy, Ashok, MD, Fink, Ericka L., MD, MS
Format: Article
Language:English
Subjects:
Adolescent
Cerebrovascular Circulation
Child
Child, Preschool
Diffusion Magnetic Resonance Imaging
Female
Heart Arrest - physiopathology
Humans
Infant
Infant, Newborn
Male
Pediatrics
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Summary:Objective To quantify and examine the relationship between global and regional cerebral blood flow (CBF) and water diffusion on brain magnetic resonance imaging (MRI) in children after cardiac arrest. Study design Children admitted to a tertiary care children's hospital from July 2011 to April 2013 who received a brain MRI within 2 weeks after cardiac arrest that included arterial spin labeling and apparent diffusion coefficient (ADC) sequences were studied. CBF and ADC values were calculated globally and in 19 regions of interest. Outcome variables included survival and favorable neurologic outcome, which was defined as Pediatric Cerebral Performance Category ≤3 at 6 months. We examined global and regional relationships between CBF and ADC and their association with outcome. Results This sample included 14 pediatric patients (mean time to MRI 6 ± 4 days), 9 of whom survived and 6 who survived with favorable outcome. Global ADC was significantly decreased in patients with unfavorable outcome ( P  = .02). Increased CBF and decreased ADC often were colocalized in the same region, especially in children who had unfavorable outcomes. Conclusions In this exploratory study, global restricted water diffusion on ADC after pediatric cardiac arrest was associated with unfavorable outcome. MRI assessments of perfusion and diffusion may have prognostic value after pediatric cardiac arrest.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2015.10.003