title: Prognostication of cardiac arrest survivors using low apparent diffusion coefficient cluster volume.
abstract: BACKGROUND
  We developed a new neuroprognostication method for cardiac arrest (CA) using the relative volume of the most dominant cluster of low apparent diffusion coefficient (ADC) voxels and tested its performance in a multicenter setting.
  
  
  METHODS
  Adult (>15 years) out-of-hospital CA patients from three different facilities who underwent an MRI 12h after resuscitation were retrospectively analyzed. Patients with unknown long-term prognosis or poor baseline neurologic function were excluded. Average ADCs (mean and median), LADCV (relative volume of low-ADC voxels) and DC-LADCV (relative volume of most dominant cluster of low-ADC voxels) were extracted using different thresholds between 400 and 800 × 10(-6) mm(2) s(-1) at 10 × 10(-6) mm(2) s(-1) intervals. Area under the receiver operating characteristic curve (AUROC) and sensitivity for poor outcome (6-month cerebral performance category score >2) while maintaining 100% specificity were measured.
  
  
  RESULTS
  110 patients were analyzed. Average ADCs showed fair performance with an AUROC of 0.822 (95% confidence interval [CI], 0.744-0.900) for the mean and 0.799 (95% CI, 0.716-0.882) for the median. LADCV showed better performance with a higher AUROC (maximum, 0.925) in an ADC threshold range of 400 to 690 × 10(-6) mm(2) s(-1). DC-LADCV showed the best performance with a higher AUROC (maximum, 0.955) compared with LADCV in an ADC threshold range of 600 to 680 × 10(-6) mm(2) s(-1). DC-LADCV had a high sensitivity for poor outcomes (>80%) in a wide threshold range from 400 to 580 × 10(-6) mm(2) s(-1) with a maximum of 89.2%.
  
  
  CONCLUSIONS
  Quantitative analysis using DC-LADCV showed impressive performance in determining the prognosis of out-of-hospital CA patients in a multicenter setting.
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Joonghee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea. Electronic address: dremkks@snubh.org.
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea.
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Suh
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea.
authors.forename: Woon Yong
authors.initials: WY
authors.lastname: Kwon
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea.
authors.forename: Kyung Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul 156-707, Republic of Korea.
authors.forename: Jonghwan
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul 156-707, Republic of Korea.
authors.forename: Huijai
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 443-721, Republic of Korea.
authors.forename: Sang-Cheon
authors.initials: SC
authors.lastname: Choi
authors.affiliation: Hankuk University of Foreign Studies, Department of Digital Information Engineering, 107 Imun-ro, Dongdaemun-gu, Seoul 130-791, Republic of Korea.
authors.forename: Il Dong
authors.initials: ID
authors.lastname: Yun
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Byung Se
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Taeyun
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Gyeonggi-do, Republic of Korea.
authors.forename: Chulmin
authors.initials: C
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001921:Brain / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017741:Survivors
keywords: Brain ischemia; Cardiac arrest; Coma; Computer-assisted image analyses; Magnetic resonance imaging; Prognosis