Prognostic value of a qualitative brain MRI scoring system after cardiac arrest

J Neuroimaging. 2015 May-Jun;25(3):430-7. doi: 10.1111/jon.12143. Epub 2014 Jul 15.


Background and purpose: To develop a qualitative brain magnetic resonance imaging (MRI) scoring system for comatose cardiac arrest patients that can be used in clinical practice.

Methods: Consecutive comatose postcardiac arrest patients were prospectively enrolled. Routine MR brain sequences were scored by two independent blinded experts. Predefined brain regions were qualitatively scored on the fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) sequences according to the severity of the abnormality on a scale from 0 to 4. The mean score of the raters was used. Poor outcome was defined as death or vegetative state at 6 months.

Results: Sixty-eight patients with 88 brain MRI scans were included. Median time from the arrest to the initial MRI was 77 hours (IQR 58-144 hours). At 100% specificity, the "cortex score" performed best in predicting unfavorable outcome with a sensitivity of 55%-60% (95% CI 41-74) depending on time window selection. When comparing the "cortex score" with historically used predictors for poor outcome, MRI improved the sensitivity for poor outcome over conventional predictors by 27% at 100% specificity.

Conclusions: A qualitative MRI scoring system helps assess hypoxic-ischemic brain injury severity following cardiac arrest and may provide useful prognostic information in comatose cardiac arrest patients.

Keywords: Diffusion weighted MRI; anoxic brain injury; cardiac arrest; prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Coma / etiology*
  • Coma / pathology*
  • Female
  • Heart Arrest / complications*
  • Heart Arrest / diagnosis*
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Observer Variation
  • Prognosis
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Single-Blind Method