학술논문
Abstract 317: Brain MRI And Spectroscopy Biomarkers Predict Outcome After Pediatric Cardiac Arrest In POCCA
Document Type
Academic Journal
Author
Fink, Ericka L; Kochanek, Patrick M; Bluml, Stefan; Wisnowski, Jessica; Narayanan, Srikala; subramanian, subramanian; Beers, Sue; Berger, Rachel; Bayir, Hulya; Wang, Chunyan; Pineda, Jose; Topjian, Alexis A; maddux, aline; Willyerd, Frederick; Hunt, Elizabeth A; Chung, Melissa G; Newth, Christopher; Smith, Lincoln; Doughty, Lesley; Diddle, J. Wesley; Piantino, Juan; Walson, Karen H; Balakrishnan, Binod; friess, stuart; Siems, Ashley; Press, Craig; Patregnani, Jason; Meyer, Michael T; Haller, Tamara; Treble-Barna, Amery; Clark, Robert; Fabio, Anthony; Panigrahy, Ashok
Source
Circulation. Nov 08, 2022 146(Suppl_1 Suppl 1):A317-A317
Subject
Language
English
ISSN
0009-7322
Abstract
Conventional (T2) and diffusion-weighted imaging (DWI) on brain magnetic resonance imaging (MRI) and lactate and N-acetyl-aspartate (NAA) on MR spectroscopy (MRS) can characterize brain hypoxic-ischemic injury. We hypothesized these neuroimaging biomarkers would be associated with 1 year outcome after pediatric cardiac arrest in a multicenter, observational study. Fourteen US centers enrolled children aged < 18 years with pediatric intensive care unit admission post-arrest if pre- arrest Pediatric Cerebral Performance Category score was 1-3. Brain MRI/MRS performed within 2 weeks post-arrest were analyzed independently by 2 pediatric neuroradiologists blinded to outcome. MRI lesions on T2 and DWI were scored by region and severity (0=none, 1=mild, 2=moderate, 3=severe). Total MRI score was a sum of T2 and DWI lesions in gray and white matter (max 34). Lactate and NAA were measured in the basal ganglia, thalamus, and occipital-parietal white/gray matter and quantified by LCModel. Multivariate regression was performed to determine the association with unfavorable outcome (Vineland Adaptive Behavioral Scale < 70 or dead at 1 year). Of 164 children, 66 and 32 had evaluable MRI and MRS data and 23 (35%) and 12 (38%) had unfavorable outcome, respectively. Children with unfavorable outcome had more unwitnessed and out-of-hospital events. DWI lesions in all 4 lobes predicted unfavorable outcome, whereas T2 temporal gray and parietal white matter lesions predicted unfavorable outcome, p<0.05. T2/DWI lesions in the basal ganglia, thalamus, and centrum semi-ovale predicted unfavorable outcome, p<0.05. Cerebellar/ brain stem white matter lesions predicted unfavorable outcome, p<.05. Total MRI scores were markedly higher in the unfavorable group (median [interquartile range]) (22 [7, 32] vs. 1 [0,8], p<0.001). Increased lactate and decreased NAA predicted unfavorable outcome in all 4 regions of interest, p<0.05. In a multivariate logistic regression, MRI total score (odds ratio 1.12 [95% confidence interval 1.05, 1.20]) and witnessed event status (0.07 [0.01, 0.34]) predicted outcome. Brain MRI and MRS biomarkers are useful to identify children with unfavorable outcome within 2 weeks post-cardiac arrest.