title: Early brain computed tomography findings are associated with outcome in patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest.
abstract: BACKGROUND
  This study evaluated the association between the results of immediate brain computed tomography (CT) scans and outcome in patients who were treated with therapeutic hypothermia after cardiac arrest. The evaluation was based on the changes in the ratio of gray matter to white matter.
  
  
  METHODS
  A total of 167 patients who were successfully resuscitated after cardiac arrest from March 2009 to December 2011 were included in this study. We selected 51 patients who received a brain CT scan within 1 hour after the return of spontaneous circulation (ROSC) and who had been treated with therapeutic hypothermia. Circular regions of measurement (10 mm2) were placed over regions of interest (ROIs), and the average attenuations in gray matter (GM) and white matter (WM) were recorded in the basal ganglia, at the level of the centrum semiovale and in the high convexity area. Three GM-to-WM ratios (GWRs) were calculated: one for the basal ganglia, one for the cerebrum and the average of the two. The neurological outcomes were assessed using the Cerebral Performance Category (CPC) scale at the time of hospital discharge, and a good neurological outcome was defined as a CPC score of 1 or 2.
  
  
  RESULTS
  The average GWR was the strongest predictor of poor neurological outcome as determined using receiver operating characteristic curves (basal ganglia area under the curve (AUC) = 0.716; cerebrum AUC = 0.685; average AUC = 0.747). An average GWR < 1.14 predicted a poor neurological outcome with a sensitivity of 13.3% (95% confidence interval (CI) 3.8-30.7), a specificity of 100% (95% CI 83.9-100), a positive predictive value of 100% (95% CI 2.5-100), and a negative predictive value of 44.7% (CI 28.9-58.9).
  
  
  CONCLUSIONS
  Our study demonstrated that low GWRs in the immediate brain CT scans of patients treated with therapeutic hypothermia after ROSC were associated with poor neurological outcomes. Immediate brain CT scans could help predict outcome after cardiac arrest.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Seung Pill
authors.initials: SP
authors.lastname: Choi
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
authors.forename: Chun Song
authors.initials: CS
authors.lastname: Youn
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Oh
authors.forename: Se Min
authors.initials: SM
authors.lastname: Choi
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D006801:Humans; D007036:Hypothermia, Induced; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012372:ROC Curve; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome