Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study
Abstract Diffusion-weighted magnetic resonance imaging (DW-MRI) performed before target temperature management, within 6 h of return of spontaneous circulation (ROSC), is defined as ultra-early DW-MRI. In previous studies, high-signal intensity (HSI) on ultra-early DW-MRI can predict poor neurologic...
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Nature Portfolio
2024-10-01
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| Online Access: | https://doi.org/10.1038/s41598-024-76418-6 |
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| author | Jung Soo Park Changshin Kang Jin Hong Min Yeonho You Wonjoon Jeong Hong Joon Ahn Yong Nam In Young Min Kim Se Kwang Oh So Young Jeon In Ho Lee Hye Seon Jeong Byung Kook Lee |
| author_facet | Jung Soo Park Changshin Kang Jin Hong Min Yeonho You Wonjoon Jeong Hong Joon Ahn Yong Nam In Young Min Kim Se Kwang Oh So Young Jeon In Ho Lee Hye Seon Jeong Byung Kook Lee |
| author_sort | Jung Soo Park |
| collection | DOAJ |
| description | Abstract Diffusion-weighted magnetic resonance imaging (DW-MRI) performed before target temperature management, within 6 h of return of spontaneous circulation (ROSC), is defined as ultra-early DW-MRI. In previous studies, high-signal intensity (HSI) on ultra-early DW-MRI can predict poor neurological outcomes (Cerebral Performance Category 3–5 at 6-months post-ROSC). We aimed to assess the optimal-timing for ultra-early DW-MRI to avoid false-negative outcomes post out-of-hospital cardiac arrest, considering cardiopulmonary resuscitation (CPR) factors. The primary outcomes were HSI in the cerebral cortex or deep gray matter on ultra-early DW-MRI. The impact of CPR factors and ROSC to DW-MRI scan-interval on HSI-presence was assessed. Of 206 included patients, 108 exhibited HSI-presence, exclusively associated with poor neurological outcomes. In multivariate regression analysis, ROSC to DW-MRI scan-interval (adjusted odds ratio [aOR], 1.509; 95% confidence interval (CI): 1.113–2.046; P = 0.008), low-flow time (aOR, 1.176; 95%CI: 1.121–1.233; P < 0.001), and non-shockable rhythm (aOR, 9.974; 95%CI: 3.363–29.578; P < 0.001) were independently associated with HSI-presence. ROSC to DW-MRI scan-interval cutoff of ≥ 2.2 h was particularly significant in low-flow time ≤ 21 min or shockable rhythm group. In conclusion, short low-flow time and shockable rhythm require a longer ROSC to DW-MRI scan-interval. Prolonged low-flow time and non-shockable rhythm reduce the need to consider scan-interval. |
| format | Article |
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| institution | OA Journals |
| issn | 2045-2322 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-2aacf5f43d0d4ad7b84dcdc54c764ba72025-08-20T02:11:28ZengNature PortfolioScientific Reports2045-23222024-10-0114111210.1038/s41598-024-76418-6Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort studyJung Soo Park0Changshin Kang1Jin Hong Min2Yeonho You3Wonjoon Jeong4Hong Joon Ahn5Yong Nam In6Young Min Kim7Se Kwang Oh8So Young Jeon9In Ho Lee10Hye Seon Jeong11Byung Kook Lee12Department of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, Chungbuk National University HospitalDepartment of Emergency Medicine, College of Medicine, Chungnam National UniversityDepartment of Emergency Medicine, Chungnam National University HospitalDepartment of Radiology, College of Medicine, Chungnam National UniversityDepartment of Neurology, Chungnam National University HospitalDepartment of Emergency Medicine, Chonnam National University Medical School, Chonnam National University HospitalAbstract Diffusion-weighted magnetic resonance imaging (DW-MRI) performed before target temperature management, within 6 h of return of spontaneous circulation (ROSC), is defined as ultra-early DW-MRI. In previous studies, high-signal intensity (HSI) on ultra-early DW-MRI can predict poor neurological outcomes (Cerebral Performance Category 3–5 at 6-months post-ROSC). We aimed to assess the optimal-timing for ultra-early DW-MRI to avoid false-negative outcomes post out-of-hospital cardiac arrest, considering cardiopulmonary resuscitation (CPR) factors. The primary outcomes were HSI in the cerebral cortex or deep gray matter on ultra-early DW-MRI. The impact of CPR factors and ROSC to DW-MRI scan-interval on HSI-presence was assessed. Of 206 included patients, 108 exhibited HSI-presence, exclusively associated with poor neurological outcomes. In multivariate regression analysis, ROSC to DW-MRI scan-interval (adjusted odds ratio [aOR], 1.509; 95% confidence interval (CI): 1.113–2.046; P = 0.008), low-flow time (aOR, 1.176; 95%CI: 1.121–1.233; P < 0.001), and non-shockable rhythm (aOR, 9.974; 95%CI: 3.363–29.578; P < 0.001) were independently associated with HSI-presence. ROSC to DW-MRI scan-interval cutoff of ≥ 2.2 h was particularly significant in low-flow time ≤ 21 min or shockable rhythm group. In conclusion, short low-flow time and shockable rhythm require a longer ROSC to DW-MRI scan-interval. Prolonged low-flow time and non-shockable rhythm reduce the need to consider scan-interval.https://doi.org/10.1038/s41598-024-76418-6Cardiopulmonary resuscitationDiffusion magnetic resonance imagingOut-of-hospital cardiac arrestReturn of spontaneous circulationPost-cardiac arrest syndrome |
| spellingShingle | Jung Soo Park Changshin Kang Jin Hong Min Yeonho You Wonjoon Jeong Hong Joon Ahn Yong Nam In Young Min Kim Se Kwang Oh So Young Jeon In Ho Lee Hye Seon Jeong Byung Kook Lee Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study Scientific Reports Cardiopulmonary resuscitation Diffusion magnetic resonance imaging Out-of-hospital cardiac arrest Return of spontaneous circulation Post-cardiac arrest syndrome |
| title | Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study |
| title_full | Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study |
| title_fullStr | Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study |
| title_full_unstemmed | Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study |
| title_short | Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study |
| title_sort | optimal timing of ultra early diffusion weighted mri in out of hospital cardiac arrest patients based on a retrospective multicenter cohort study |
| topic | Cardiopulmonary resuscitation Diffusion magnetic resonance imaging Out-of-hospital cardiac arrest Return of spontaneous circulation Post-cardiac arrest syndrome |
| url | https://doi.org/10.1038/s41598-024-76418-6 |
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