Journal List > Korean J Clin Neurophysiol > v.15(2) > 1084119

Kim, Noh, Lim, Kim, Yun, and Park: Role of Diffusion-Weighted Imaging as a Prognostic Indicator in Acute Hypoxic Encephalopathy

Abstract

Background:

Diffusion-weighted image (DWI) might be useful to predict the prognosis of acute hypoxic encephalopathy. The aim of our study was to test whether the early change and extent of DWI abnormalities can be an indicator of the clinical outcome of hypoxic encephalopathy.

Methods:

Forty-four patients who were diagnosed as hypoxic encephalopathy due to the cardiorespiratory arrest were retrospectively identified. Clinical variables were determined, and the DWI abnormalities were counted by four areas: cortex, subcortical white matter, cerebellum and deep grey matter, and were divided into three groups by the extent of lesions. Prognosis was classified as ‘poor’ (Glasgow coma scale (GSC) at 30 days after arrest <9 or death) and ‘good’ (GSC at 30 days after arrest ≥9).

Results:

GCS at day 3 (p<0.001), presence of seizure (p=0.01), and presence of lesion (p<0.001) were significantly different in prognosis, but statistically there is no association with the extent of lesions and prognosis (p=0.26).

Conclusions:

Presence of early DWI changes could predict the clinical outcome of hypoxic encephalopathy after cardiorespiratory arrest.

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Table 1.
Categorization of patients according to the distribution of lesions on the diffusion-weighted image
Location of lesion n Number of lesion (n) Extent of lesion (n)
None 19 0 (19) None (19)
Ctx only 3 1 (5)
DG only 2 Group I (7)
Ctx + Cbll 2
Ctx + WM 1 2 (12)
DG + WM 1 Group II (12)
Ctx + DG 8
Ctx + DG + Cbll 2 3 (3)
Ctx + DG + WM Ctx + DG + WM + Cbll 1 5 4 (5) Group III (6)

Ctx; cortex, DG; deep gray matter, WM; subcortical white matter, Cbll; cerebellum.

Table 2.
General characteristics
Total (n=44) Good Px (n=16) Poor Px (n=28) p-value
Age (yr) 54.40±16.47 48.50±14.01 57.79±17.46 0.08
Male (n) 34 (77.27%) 12 (75%) 22 (78.57%) 0.99
Arrest type 0.32
Cardiac arrest 26 (59.09%) 9 (56.25%) 17 (60.71%)
Respiratory arrest 14 (31.82%) 5 (31.25%) 9 (32.14%)
Anemic hypoxic 2 (4.55%) 2 (12.50%) 0
Unknown 2 (4.55%) 0 2 (7.14%)
Arrest place-Out H. (n) 31 (70.45%) 11 (68.75%) 20 (71.43%) 0.99
Initial GCS score 3.84±1.64 4.38±2.25 3.54±1.11 0.10
GCS score at day 3 4.77±3.51 8.88±2.34 3.07±0.77 <0.001*
Time to DWI after ROSC (day) 2.45±2.18 3.09±2.70 2.08±1.76 0.14
Seizure (n) 17 (38.64%) 2 (12.50%) 15 (53.57%) 0.01*
Hypothermia (n) 13 (29.55%) 6 (37.50%) 7 (25%) 0.50
Lesion positive (n) 25 (56.82%) 2 (12.50%) 23 (82.14%) <0.001*
Extent of lesion 0.26
Group I (n) 7 1 6
Group II (n) 12 0 12
Group III (n) 6 1 5
 

* p<0.05.

n; number, Px; prognosis, Out H.; out of hospital, GCS; Glasgow coma scale, DWI; Diffusion weighted image, ROSC; return of spontaneous circulation.

Table 3.
Characteristics of lesion by MRI tesla (T)
MRI 1.5T (n=37) MRI 3T (n=7) p-value
Lesion positive (n) 20 (54.05%) 5 (71.43%) 0.68
Number of lesion (n) 1.16±1.30 2.14±1.68 0.09
Table 4.
Simple logistic regression analysis
p-value Odds Ratio 95% CI
Age 0.08 1.04 1.00-1.08
GCS score at day 3 0.01 0.20 0.06-0.66
Seizure 0.01 8.08 1.54-42.37
Lesion positive <0.001 32.20 5.49-188.91

CI; confidence interval.

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