The Usefulness of Proton Magnetic Resonance Spectroscopy in Comatose Patients after Successful Cardiopulmonary Resuscitation

ABSTRACT

PURPOSE: The objective of this study was to investigate whether proton magnetic resonance spectroscopy (1H-MRS) is useful in the prediction of the neurological outcome for comatose patients after successful cardiopumonary resuscitation (CPR). METHODS: We prospectively studied 22 patients with a comatose mentality existing for longer than 1 day after cardiac arrest. 1H-MRS examinations were scheduled to be performed within 5 days after restoration of spontaneous circulation (ROSC). All 1H-MRS readings were performed by a neuro-radiologist blindly. The best cerebral performance category (CPC) during 6 months after ROSC was used as the final outcome and classified as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Elevated cerebral lactate resonances were found in 14 patients. All of the 14 lactate-positive patients experienced a poor outcome. Five of the 8 lactate-negative patients recovered without neurologic defects, but three of them suffered from severe neurologic defects. The elevated cerebral lactate resonance distinguished between good out-comes (n=5) and poor outcomes (n=17) with three false negatives (sensitivity 82%) and no false positives (specificit y 100%). Demonstration of brain lactate in 1H-MRS (p < 0.05) proved to be significant in terms of a poor prognosis. CONCLUSION: 1H-MRS is of great benefit in the prognostic evaluation of comatose patients with anoxic-ischemic encephalopathy after successful CPR.