Prognostic Value of Brain Magnetic Resonance Imaging in Children After Out-of-Hospital Cardiac Arrest: Predictive Value of Normal Magnetic Resonance Imaging for a Favorable Two-Year Outcome

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-02-03 DOI:10.1016/j.pediatrneurol.2025.01.023

Marijn Albrecht MD , Rogier de Jonge MD, PhD , Corinne Buysse MD, PhD , Marjolein H.G. Dremmen MD , Anke W. van der Eerden MD, PhD , Matthijs de Hoog MD, PhD , Dick Tibboel MD, PhD , Maayke Hunfeld MD, PhD

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Abstract

Background

Determine the predictive value of brain magnetic resonance imaging (MRI) findings less than or equal to seven days post–pediatric out-of-hospital cardiac arrest (OHCA) for long-term outcomes.

Methods

This retrospective single-center study included children (zero to 17 years) with OHCA admitted to a tertiary care hospital pediatrc intensive care unit from 2012 to 2020 who underwent brain MRI at most seven days postarrest. A neuroimaging scoring system was designed, using T1-, T2-, and diffusion-weighted images based on previously published scores and brain injury patterns. Extensive brain injury was defined as ≥50% cortex/white matter injury or four or more of nine predefined brain regions. Pediatric cerebral performance category (PCPC) scores were determined at hospital discharge and two years post-OHCA as part of routine follow-up care. Favorable neurological outcomes were defined as PCPC scores of 1 to 2 or no change from prearrest status.

Results

Among 142 children, 56 had a brain MRI at less than or equal to seven days postarrest. Median arrest age was 3.3 years (first and third quartiles [Q1, Q3]: 0.6, 13.6), and 64% were male. Brain MRI was obtained four days post-OHCA (Q1, Q3: 3, 5). Normal brain MRI findings (i.e., negative test result) predicted favorable outcomes with 100% negative predictive value, whereas extensive injury (i.e., positive test result) predicted unfavorable outcomes and death with 100% positive predictive value.

Conclusions

A normal brain MRI at less than or equal to seven days postarrest predicts favorable neurological outcomes two years later, whereas extensive brain injury predicts unfavorable neurological outcomes or death at discharge and two years post-OHCA.

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院外心脏骤停后儿童脑磁共振成像的预后价值：正常磁共振成像对两年有利预后的预测价值

确定儿童院外心脏骤停（OHCA）后小于或等于7天的脑磁共振成像（MRI）结果对长期预后的预测价值。方法本回顾性单中心研究纳入2012年至2020年在三级医院儿科重症监护室就诊的OHCA患儿（0 - 17岁），这些患儿在出院后最多7天接受脑MRI检查。基于先前公布的评分和脑损伤模式，设计了一个神经影像学评分系统，使用T1、T2和弥散加权图像。广泛脑损伤定义为≥50%的皮质/白质损伤或9个预定义脑区中的4个或更多。作为常规随访护理的一部分，在出院时和ohca后两年测定儿童脑功能分类（PCPC）评分。良好的神经预后定义为PCPC评分为1至2分或与骤停前状态没有变化。结果142例患儿中，56例患儿在术后少于或等于7天进行了脑MRI检查。中位被捕年龄为3.3岁（第一和第三四分位数[Q1， Q3]: 0.6岁，13.6岁），64%为男性。ohca后4天进行脑MRI （Q1, Q3: 3,5）。正常的脑MRI结果（即阴性检测结果）预测预后良好，其预测值为100%阴性，而大面积损伤（即阳性检测结果）预测预后不良和死亡，其预测值为100%阳性。结论：休息后少于或等于7天的正常脑MRI预测两年后良好的神经系统预后，而大面积脑损伤预测不良的神经系统预后或出院后和ohca后2年死亡。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.