One hundred ninety-three patients also had continuous (n = 186) or routine (n = 7) EEG data. Specifically, we sought to address whether global or regional diffusion MRI–measured ADC values showed a stronger association with DoC, suppression of the EEG background, and epileptic seizures. Here, we use diffusion MRI from a large clinical cohort to define the anatomic distribution of ABI after cardiac arrest and to identify associations between patterns of injury and common clinical and electrographic abnormalities. Furthermore, given an increasingly multimodal approach to prognostication after cardiac arrest, 22 - 24 an improved understanding of the associations between modalities will facilitate interpretation of discrepant results. 13 Investigating the associations between regional anoxic injury and the clinical and electrographic sequalae of cardiac arrest may help identify specific brain circuits responsible for their production. It remains unclear whether common clinical and electrographic abnormalities after cardiac arrest such as DoC, a suppressed EEG background, and postanoxic seizures reflect the overall severity of ABI, as measured with whole-brain or whole-cortex ADC values, or injury to specific structures. 20 Previous work has demonstrated that greater ADC reductions across the whole brain or cortex are associated with poorer outcomes. 14 - 19 In animal models of ABI, reductions in the apparent diffusion coefficient (ADC) are associated with the histopathologic volume of infarcted brain tissue. 3, 13ĭiffusion MRI is the most sensitive imaging modality for the clinical characterization of ABI. Furthermore, although disorders of consciousness (DoC), 4, 5 EEG background suppression, 6, 7 and seizures 7 - 10 predict poor neurologic outcomes after cardiac arrest, 3, 11, 12 the regional patterns of anoxic brain injury (ABI) associated with each are unknown. Neuropathologic studies in animals 1 and humans 2, 3 have identified numerous brain regions susceptible to anoxic injury, but a map of brain regions affected by cardiac arrest does not yet exist. Last, using area under receiver operating characteristic curves, we then compared the classification ability of the strongest regional associations to that of brain-wide summary measures.
We then used a bootstrapped lasso regression procedure to identify robust, multivariate regional associations with each outcome variable. We identified ADC abnormalities relative to controls without cardiac arrest (n = 48) and used voxel lesion symptom mapping to identify regional associations with disorders of consciousness, EEG background suppression, and seizures. Anoxic brain injury was measured with the apparent diffusion coefficient (ADC) signal. We classified each patient according to recovery of consciousness (command following) before discharge, the most continuous EEG background (burst suppression vs continuous), and the presence or absence of seizures. We analyzed patients from a single-center database of unresponsive patients who underwent diffusion MRI after cardiac arrest (n = 204). Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Charlestown and Department of Neurology (M.D.F.), Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. From the Division of Neurocritical Care, Department of Neurology, (S.B.S., D.F., M.E.M., M.B.B.), Departments of Neurology, Psychiatry, and Radiology (A.L.C., F.L.W.V.J.S., M.D.F.), Center for Brain Circuit Therapeutics, Division of Cardiology, Department of Medicine (B.S.), and Division of Epilepsy, Department of Neurology (J.W.L.), Brigham and Women's Hospital, Harvard Medical School Departments of Neurology and Radiology (A.L.C.), Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, MA Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California at San Francisco Neurology Service (E.A.), Zuckerberg San Francisco General Hospital, CA Departments of Neurology and Radiology (M.D.F.), Athinoula A.
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