Comparison of Prognostic Value of Early Phase 1H Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging With Neuron-Specific Enolase at 72 Hours in Comatose Survivors of Out-of-hospital Cardiac Arrest – A Sub-Study of the Xe-Hypotheca Trial
Background
Guidelines recommend brain imaging for neurological prognostication after out-of-hospital cardiac arrest (OHCA). We aimed to evaluate the predictive accuracy of early phase diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1H-MRS) combined with neuron-specific enolase (NSE)and selected clinical variables for poor neurological outcome after OHCA.
Methods
In 92 patients with complete data set, the predictive accuracy of DTI, 1H-MRS, and NSE at 72h for poor neurological outcome (mRS 3-6) at six months were assessed by area under the receiver operating characteristic (ROC) curve as predetermined in the protocol. Additional post-hoc analyses were also performed to find a model with the best predictive power for poor neurological outcome. The brain imaging was performed in a median (IQR) time of 53 hours (47-64) after OHCA.
Results
At six-months, 31 patients had mRS 3-6, considered to reflect a poor neurological outcome. There was no significant difference between area under ROC curve of 0.73 (95% CI 0.62-0.84) for DTI, 0.78 (0.68-0.88) for 1H-MRS and 0.85 (0.76-0.93) for NSE at 72h for predicting poor outcome at 6 months. In the post-hoc analysis, the combination of DTI, 1H-MRS, and NSE with motor score at 72 hours and epileptic seizures provided the best predictive power with area under ROC curve of 0.98 (95% CI 0.96 – 1.00) as compared to 0.92 (0.86 − 0.97) for DTI, 1H-MRS and NSE at 72 hours alone (p = 0.009).
Conclusions
Neither early stage DTI nor 1H-MRS imaging was better than NSE at 72h in predicting poor outcome in this patient group. Although the addition of neuroimaging to the best model using current clinical and laboratory parameters improved the diagnostic performance, the costs and challenges of MR imaging of critically ill patients may outweigh this small benefit.
Trial registration
ClinicalTrials.gov NCT00879892. Registered on 13 April 2009.
Publisher URL: https://www.researchsquare.com/article/rs-86989/latest
Open URL: https://www.researchsquare.com/article/rs-86989/v1.pdf
DOI: 10.21203/rs.3.rs-86989/v1
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