Magnetic Resonance Imaging As a Outcome Predictor in Comatose Survivors after Cardiac Arrest

ABSTRACT

PURPOSE: The prognosis of comatose survivors after cardiac arrest is predicted by various methods such as neuralagic examination, magnetic resonance spectroscopy (MRS), biochemical markers, and somatosensory-evoked potentials (SSEP). The objective of this study was to investigate differences in magnetic resonance imaging (MRI) findings between good (CPC 1-2) and poor (CPC 3-5) outcome for comatose survivors after cardiac arrest. METHODS: We retrospectively studied the cases of 19 comatose survivors after cardiac arrest who underwent MRI between March 1, 1997 and August 31, 1999. All MRI readings were performed by a neuro radiologist blindly and best CPC during 6 months after ROSC was used as final outcome. RESULTS: Sixteen of the 19 patients had abnormal findings on the T2-weighted images hippocampal infarct in 13 (68%), basal ganglia/thalamic infarct in 9 (47%), cortical infarct in 7 (37%), cortical watershed infarct in 6 (32%), and cerebellar infarct in 5 (26%). Among 6 patients with good outcome (CPC 1-2), 4 patients (67%) had hippocampal infarct, 1 (17%) basal ganglia/thalamic infarct, 1 (17%) white matter infarct, and 1 (17%) cerebellar infarct. Among the 13 patients with poor outcomes (CPC 3-5), 9 patients (69%) had hippocampal infarct, 8 (62%) basal ganglia/thalamic infarct, 7 (54%) cortical infart, 6 (46%) cortical watershed infarct, and 4 (31%) cerebellar infarct. Cortical and cortical watershed infarcts were only detected in patients with poor outcomes (p<0.05). CONCLUSION: On the MRI findings, comatose survivors after cardiac arrest were susceptible to hippocampus, basal ganglia/thalamus, cortex, cortical watershed, and cerebellar infarts. Cortical and cortical watershed infarcts may be useful as a prognostic tool for comatose survivor after cardiac arrest.