Role of Diffusion-Weighted Imaging as a Prognostic Indicator in Acute Hypoxic Encephalopathy

Jin-Soo Kim; Won-Young Noh; Jae-Sung Lim; Seon-Jeong Kim; Chang-Ho Yun; Seong-Ho Park

doi:10.14253/kjcn.2013.15.2.42

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

Original Article

Korean J Community Nutr 2013;15(2):42-47.

Published online: 19 January 2013

DOI: https://doi.org/10.14253/kjcn.2013.15.2.42

Role of Diffusion-Weighted Imaging as a Prognostic Indicator in Acute Hypoxic Encephalopathy

Jin-Soo Kim^1,², Won-Young Noh¹, Jae-Sung Lim³, Seon-Jeong Kim⁴, Chang-Ho Yun^1,², Seong-Ho Park^1,²

¹Department of Neurology, Seoul National University College of Medicine, Seoul, Korea

²Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea

³Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea

⁴Department of Neurology, Howard Hill Hospital, Yongin, Korea

Address for correspondence; Seong-Ho Park Department of Neurology, Seoul National University Bundang Hospital, 82 Gumi-ro 173Beon-gil, Bundang-gu, Seongnam 463-707, Korea Tel: +82-31-787-7461 Fax: +82-31-787-4059 E-mail: nrpsh@snu.ac.kr

Received 14 January 201328 June 2013 Accepted 16 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Hypoxic encephalopathy, Diffusion-weighted image, Prognosis

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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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