title: Prognostic value of a qualitative brain MRI scoring system after cardiac arrest.
abstract: OBJECTIVE
  To develop a qualitative brain magnetic resonance imaging (MRI) scoring system for comatose cardiac arrest patients that can be used in clinical practice.
  
  
  METHODS
  Consecutive comatose postcardiac arrest patients were prospectively enrolled. Routine MR brain sequences were scored by two independent blinded experts. Predefined brain regions were qualitatively scored on the fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) sequences according to the severity of the abnormality on a scale from 0 to 4. The mean score of the raters was used. Poor outcome was defined as death or vegetative state at 6 months.
  
  
  RESULTS
  Sixty-eight patients with 88 brain MRI scans were included. Median time from the arrest to the initial MRI was 77 hours (IQR 58-144 hours). At 100% specificity, the "cortex score" performed best in predicting unfavorable outcome with a sensitivity of 55%-60% (95% CI 41-74) depending on time window selection. When comparing the "cortex score" with historically used predictors for poor outcome, MRI improved the sensitivity for poor outcome over conventional predictors by 27% at 100% specificity.
  
  
  CONCLUSIONS
  A qualitative MRI scoring system helps assess hypoxic-ischemic brain injury severity following cardiac arrest and may provide useful prognostic information in comatose cardiac arrest patients.
authors.affiliation: Stanford Neurocritical Care Program, Stanford Stroke Center, Stanford University Medical Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Karen G
authors.initials: KG
authors.lastname: Hirsch
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.forename: Sofie
authors.initials: S
authors.lastname: Jansen
authors.forename: Suzanne
authors.initials: S
authors.lastname: Persoon
authors.forename: Irina
authors.initials: I
authors.lastname: Eyngorn
authors.forename: Michael V
authors.initials: MV
authors.lastname: Krasnokutsky
authors.forename: Christine A C
authors.initials: CA
authors.lastname: Wijman
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
mesh_terms: D000465:Algorithms; D003128:Coma / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method
keywords: Diffusion weighted MRI; anoxic brain injury; cardiac arrest; prognosis