title: Regional brain injury on conventional and diffusion weighted MRI is associated with outcome after pediatric cardiac arrest.
abstract: BACKGROUND
  To assess regional brain injury on magnetic resonance imaging (MRI) after pediatric cardiac arrest (CA) and to associate regional injury with patient outcome and effects of hypothermia therapy for neuroprotection.
  
  
  METHODS
  We performed a retrospective chart review with prospective imaging analysis. Children between 1 week and 17 years of age who had a brain MRI in the first 2 weeks after CA without other acute brain injury between 2002 and 2008 were included. Brain MRI (1.5 T General Electric, Milwaukee, WI, USA) images were analyzed by 2 blinded neuroradiologists with adjudication; images were visually graded. Brain lobes, basal ganglia, thalamus, brain stem, and cerebellum were analyzed using T1, T2, and diffusion-weighted images (DWI).
  
  
  RESULTS
  We examined 28 subjects with median age 1.9 years (IQR 0.4-13.0) and 19 (68 %) males. Increased intensity on T2 in the basal ganglia and restricted diffusion in the brain lobes were associated with unfavorable outcome (all P < 0.05). Therapeutic hypothermia had no effect on regional brain injury. Repeat brain MRI was infrequently performed but demonstrated evolution of lesions.
  
  
  CONCLUSIONS
  Children with lesions in the basal ganglia on conventional MRI and brain lobes on DWI within the first 2 weeks after CA represent a group with increased risk of poor outcome. These findings may be important for developing neuroprotective strategies based on regional brain injury and for evaluating response to therapy in interventional clinical trials.
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15224, USA. finkel@ccm.upmc.edu
authors.forename: Ericka L
authors.initials: EL
authors.lastname: Fink
authors.forename: A
authors.initials: A
authors.lastname: Panigrahy
authors.forename: R S B
authors.initials: RS
authors.lastname: Clark
authors.forename: C R
authors.initials: CR
authors.lastname: Fitz
authors.forename: D
authors.initials: D
authors.lastname: Landsittel
authors.forename: P M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: G
authors.initials: G
authors.lastname: Zuccoli
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000209:etiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications* / Q000473:pathology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome