Brain MR imaging and spectroscopy for outcome prognostication after pediatric cardiac arrest

Children surviving cardiac arrest are at high risk of neurological morbidity and mortality; however, there is a lack of validated prognostic biomarkers. We aimed to evaluate brain magnetic resonance imaging (MRI) and spectroscopy (MRS) as predictors of death and disability. Secondly, we evaluated wh...

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Bibliographic Details
Published in:Resuscitation 2020-12, Vol.157, p.185-194
Main Authors: Fink, Ericka L., Wisnowski, Jessica, Clark, Robert, Berger, Rachel P., Fabio, Anthony, Furtado, Andre, Narayan, Srikala, Angus, Derek C., Watson, R. Scott, Wang, Chunyan, Callaway, Clifton W., Bell, Michael J., Kochanek, Patrick M., Bluml, Stefan, Panigrahy, Ashok
Format: Article
Language:English
Subjects:
Cardiac arrest
Magnetic resonance imaging
Magnetic resonance spectroscopy
Outcome
Pediatric
Prognostication
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Summary:Children surviving cardiac arrest are at high risk of neurological morbidity and mortality; however, there is a lack of validated prognostic biomarkers. We aimed to evaluate brain magnetic resonance imaging (MRI) and spectroscopy (MRS) as predictors of death and disability. Secondly, we evaluated whether MRI/S by randomized group. This single center study analyzed clinically indicated brain MRI/S data from children enrolled in a randomized controlled trial of 24 vs. 72 h of hypothermia following cardiac arrest. Two pediatric radiologists scored conventional MRIs. Lactate and N-acetyl-aspartate (NAA) concentrations (mmol/kg) were determined from spectra acquired from the basal ganglia, thalamus, parietal white matter and parietooccipital gray matter. Mortality and neurological outcomes (favorable = Pediatric Cerebral Performance Category [PCPC] 1, 2, 3 or increase < 2) were assessed at hospital discharge. Non-parametric tests were used to test for associations between MRI/S biomarkers and outcome and randomized group. 23 children with (median [interquartile range]) age of 1.5 (0.3−4.0) years. Ten (44%) had favorable outcome. There were more T2 brain lesions in the lentiform nuclei in children with unfavorable 12 (92%) vs. favorable 3 (33%) outcome, p = 0.007. Increased lactate and decreased NAA concentrations in the parietooccipital gray matter and decreased NAA in the parietal white matter were associated with unfavorable outcome (p’s 
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2020.06.033