• Jinhee Jang, Sang Hoon Oh, Yoonho Nam, Kijeong Lee, Hyun Seok Choi, So-Lyung Jung, Kook-Jin Ahn, Kyu Nam Park, and Bum-Soo Kim.
• Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
• Resuscitation. 2019 Jul 1; 140: 142-149.

BackgroundPredicting neurological outcomes after cardiac arrest is important to guide therapeutic decisions. We assessed the prognostic value of phase information of 2D T2*-weighted gradient echo imaging (T2*WI) of the brain in CA survivors.MethodsThis study included cardiac arrest survivors who had undergone MRI for prognostication. After application of homodyne filtering to T2*WI phase images, the contrast of three venous structures was assessed as normal (score 0) or abnormal (score 1): the superior sagittal sinus, the cortical veins, and the thalamostriate veins. The scores were summarized into a gradient-recalled echo (GRE) summary score. The prognostic performances of T2*WI, diffusion-weighted imaging (DWI), electroencephalography and serum biomarkers were evaluated using receiver operating characteristic (ROC) curves.ResultsOf the 39 enrolled patients, 12 (31%) had good outcomes and 27 (69%) had poor outcomes. ROC curve analysis showed that T2*WI had good prognostic performance; the area under the curve (AUC) of the GRE summary score (0.980, 95% confidence interval CI 0.950-1.000) was comparable to those of conventional outcome predictors, including DWI patterns (0.949, 95% CI 0.889-1.000). The AUC increased when the summary GRE score was added to DWI patterns (0.991, 95% CI 0.973-1.000), although the difference was not statistically significant (P=0.117). Most subjects with isoelectric electroencephalography (5/6) showed abnormally high phase contrast in the cerebral veins.ConclusionsFiltered phase images of T2*WI showed good prognostic value and can reveal various features of the cerebral metabolic consequences of cardiac arrest, such as decreased neuronal activity and brain death-like patterns.Copyright © 2019 Elsevier B.V. All rights reserved.

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