title: Brain Gray Matter MRI Morphometry for Neuroprognostication After Cardiac Arrest.
abstract: OBJECTIVE
  We hypothesize that the combined use of MRI cortical thickness measurement and subcortical gray matter volumetry could provide an early and accurate in vivo assessment of the structural impact of cardiac arrest and therefore could be used for long-term neuroprognostication in this setting.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Five Intensive Critical Care Units affiliated to the University in Toulouse (France), Paris (France), Clermont-Ferrand (France), Liège (Belgium), and Monza (Italy).
  
  
  METHODS
  High-resolution anatomical T1-weighted images were acquired in 126 anoxic coma patients ("learning" sample) 16 ± 8 days after cardiac arrest and 70 matched controls. An additional sample of 18 anoxic coma patients, recruited in Toulouse, was used to test predictive model generalization ("test" sample). All patients were followed up 1 year after cardiac arrest.
  
  
  METHODS
  None.
  
  
  RESULTS
  Cortical thickness was computed on the whole cortical ribbon, and deep gray matter volumetry was performed after automatic segmentation. Brain morphometric data were employed to create multivariate predictive models using learning machine techniques. Patients displayed significantly extensive cortical and subcortical brain volumes atrophy compared with controls. The accuracy of a predictive classifier, encompassing cortical and subcortical components, has a significant discriminative power (learning area under the curve = 0.87; test area under the curve = 0.96). The anatomical regions which volume changes were significantly related to patient's outcome were frontal cortex, posterior cingulate cortex, thalamus, putamen, pallidum, caudate, hippocampus, and brain stem.
  
  
  CONCLUSIONS
  These findings are consistent with the hypothesis of pathologic disruption of a striatopallidal-thalamo-cortical mesocircuit induced by cardiac arrest and pave the way for the use of combined brain quantitative morphometry in this setting.
authors.affiliation: 1Department of Anaesthesiology and Critical Care, Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France.2Critical Care and Anaesthesiology Department, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France.3Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France.4Department of Anaesthesiology and Critical Care, Critical Care Unit, Hopital Dieu Hospital, Narbonne, France.5Department of Anaesthesiology and Critical Care, School of medicine and Surgery, University Milano Bicocca and Hospital San Gerardo, Monza, Italy.6Department of Neuroradiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.7Department of Anaesthesiology and Critical Care, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.8Laboratoire d'Imagerie Biomédicale (UMR S 1146/UMR 7371), Université Pierre-et-Marie-Curie-Paris 06, Paris, France.9Critical Care and Anaesthesiology Department, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France.10Department of Neuroradiology, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France.11Cyclotron Research Center and Department of Neurology, University Hospital and University of Liège, Liège, Belgium.12Algology and Palliative Care Department, University Hospital and University of Liège, Liège, Belgium.
authors.forename: Stein
authors.initials: S
authors.lastname: Silva
authors.forename: Patrice
authors.initials: P
authors.lastname: Peran
authors.forename: Lionel
authors.initials: L
authors.lastname: Kerhuel
authors.forename: Briguita
authors.initials: B
authors.lastname: Malagurski
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chauveau
authors.forename: Benoit
authors.initials: B
authors.lastname: Bataille
authors.forename: Jean Albert
authors.initials: JA
authors.lastname: Lotterie
authors.forename: Pierre
authors.initials: P
authors.lastname: Celsis
authors.forename: Florent
authors.initials: F
authors.lastname: Aubry
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.forename: Betty
authors.initials: B
authors.lastname: Jean
authors.forename: Russel
authors.initials: R
authors.lastname: Chabanne
authors.forename: Vincent
authors.initials: V
authors.lastname: Perlbarg
authors.forename: Lionel
authors.initials: L
authors.lastname: Velly
authors.forename: Damien
authors.initials: D
authors.lastname: Galanaud
authors.forename: Audrey
authors.initials: A
authors.lastname: Vanhaudenhuyse
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.forename: Louis
authors.initials: L
authors.lastname: Puybasset
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D002525:Cerebellar Cortex / Q000000981:diagnostic imaging / Q000473:pathology; D003128:Coma / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology; D006323:Heart Arrest / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies