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
Disclosure(s): No disclosures
Dr. Carmen Lopez Soto
Dr. Carmen Lopez Soto
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
#1



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

1
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

2
Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada


Objectives

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.

Methods
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.

Results
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.

Conclusions
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.

 
 

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings