Systematic Review and metanalysis on the use of imaging for neuroprognostication in patients after cardiac arrest
CCCF ePoster library. Lopez Soto C. Oct 2, 2017; 198193; 1 Disclosure(s): No disclosures
Dr. Carmen Lopez Soto
Dr. Carmen Lopez Soto
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Systematic Review and metanalysis on the use of imaging for neuroprognostication in patients after cardiac arrest

Lopez Soto, C1; Dragoi, L1; Heyn, C2; Pinto, R1; Adhikari, N1; Scales, DC1

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada


Predicting neurological outcome in comatose survivors of cardiac arrest typically relies on clinical exam findings. We systematically reviewed the literature to evaluate the predictive accuracy of neuroimaging in this context.

We searched Medline (database inception-December 2016) to retrieve  studies of computed tomography (CT) or magnetic resonance imaging (MRI) to predict poor neurological outcome in adult (>16 years) cardiac arrest survivors. We extracted methodological and outcomes data in duplicate and summarized the test performance using  meta-analyses based on bivariate model where possible and univariate models otherwise.

From 3046 citations, 32 included studies examined CT (n=15) or MRI (n=17) in a mean of 76 (range 9 to 283) patients.  Twelve studies calculated the grey:white matter ratio (GWR) of Hounsfield units.  Loss of grey-white differentiation had modest sensitivity (0.44, 95%CI 0.29-0.60) but high specificity (0.98, 0.94-0.99) for predicting poor outcome  (positive likelihood ratio (LR+) 18.3, 8.47-39.5).  Eleven studies evaluated diffusion-weighted imaging (DWI) on MRI, which had good sensitivity (0.76, 0.66-0.84) and high specificity (0.92, 0.83-0.96; LR+ 9.59, 4.63-19.9).  Five studies evaluated DWI and (fluid attenuated inversion recovery) FLAIR MRI, which had highest sensitivity (0.83, 0.69-0.91) but lower specificity (0.88, 0.67-0.97; LR+ 5.31, 1.79-15.7).   We found marked heterogeneity in the timing of radiological examinations and timing and method of neurological assessments.

CT and MRI are useful for predicting poor neurological outcome after cardiac arrest.  Low GWR on CT scan has the highest specificity and lowest false-positive rate, but also lowest sensitivity.  Future research should directly compare these tests and their additive value to clinical examination.


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