Regional Brain Injury on Conventional and Diffusion Weighted MRI is Associated with Outcome After Pediatric Cardiac Arrest

• Published in: Neurocritical care Vol. 19; no. 1; pp. 31 - 40
• Main Authors: Fink, Ericka L., Panigrahy, A., Clark, R. S. B., Fitz, C. R., Landsittel, D., Kochanek, P. M., Zuccoli, G.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.08.2013; Springer Nature B.V
• Subjects: Adolescent; Brain - pathology; Brain Injuries - etiology; Brain Injuries - pathology; Cardiac arrest; Cardiac arrhythmia; Child; Child, Preschool; Cooling; Critical Care Medicine; Data collection; Diffusion Magnetic Resonance Imaging - methods; Edema; Etiology; Female; Follow-Up Studies; Heart Arrest - complications; Heart Arrest - pathology; Humans; Hypothermia; Hypothermia, Induced - methods; Infant; Infant, Newborn; Intensive; Intensive care; Internal Medicine; Length of stay; Magnetic resonance imaging; Male; Medical records; Medicine; Medicine & Public Health; Neurology; Original Article; Pediatrics; Recovery of Function; Retrospective Studies; Traumatic brain injury; Treatment Outcome; United States > US; MRI; Neurological outcome; Pediatric; Brain injury; Cardiac arrest
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-012-9706-0

Background To assess regional brain injury on magnetic resonance imaging (MRI) after pediatric cardiac arrest (CA) and to associate regional injury with patient outcome and effects of hypothermia therapy for neuroprotection. Methods We performed a retrospective chart review with prospective imaging analysis. Children between 1 week and 17 years of age who had a brain MRI in the first 2 weeks after CA without other acute brain injury between 2002 and 2008 were included. Brain MRI (1.5 T General Electric, Milwaukee, WI, USA) images were analyzed by 2 blinded neuroradiologists with adjudication; images were visually graded. Brain lobes, basal ganglia, thalamus, brain stem, and cerebellum were analyzed using T1, T2, and diffusion-weighted images (DWI). Results We examined 28 subjects with median age 1.9 years (IQR 0.4–13.0) and 19 (68 %) males. Increased intensity on T2 in the basal ganglia and restricted diffusion in the brain lobes were associated with unfavorable outcome (all P  < 0.05). Therapeutic hypothermia had no effect on regional brain injury. Repeat brain MRI was infrequently performed but demonstrated evolution of lesions. Conclusion Children with lesions in the basal ganglia on conventional MRI and brain lobes on DWI within the first 2 weeks after CA represent a group with increased risk of poor outcome. These findings may be important for developing neuroprotective strategies based on regional brain injury and for evaluating response to therapy in interventional clinical trials.