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. 2013 May 14:21:37.
doi: 10.1186/1757-7241-21-37.

Head Computed Tomographic measurement as an early predictor of outcome in hypoxic-ischemic brain damage patients treated with hypothermia therapy

Hitoshi Yamamura, Shinichiro Kaga, Kazuhisa Kaneda, Tomonori Yamamoto, Yasumitsu Mizobata

Head Computed Tomographic measurement as an early predictor of outcome in hypoxic-ischemic brain damage patients treated with hypothermia therapy

Hitoshi Yamamura et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Neurological abnormalities are a key factor in the prognosis of patients with post-cardiac arrest syndrome. In this study, we evaluated whether differences in CT measurements expressed in Hounsfield units (HUs) of the cerebral cortex and white matter can be used as early predictors of neurological outcome in patients treated with hypothermia therapy after hypoxic-ischemic brain damage.

Methods: We performed a retrospective study of 58 patients resuscitated after cardiac arrest between 2007 and 2010 who were treated with hypothermia therapy for the initial 24 hours post resuscitation. We divided the patients into 4 groups according to Glasgow Outcome Scale (GOS) score (GOS 1, GOS 2, GOS 3&4, and GOS 5) and assessed the correlations between GOS scores and HU differences between the cerebral cortex and white matter (DCW).

Results: The HU values of the cerebral cortex gradually decreased in accordance with worsening of neurological outcome. There were no significant intergroup differences in the HUs of the white matter among the groups. The DCW values were higher in patients with good neurological outcomes. The cut-off value for DCW indicative of poor neurological outcome was less than 5.5 in the GOS 1&2 groups, with a sensitivity of 63% and a specificity of 100%.

Conclusions: This study showed that DCW values may be used for the prediction of neurological outcome of patients with post-cardiac arrest syndrome in the very early phase following the return of spontaneous circulation. Especially, a cut-off value for DCW of less than 5.5 may indicate poor neurological outcome.

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Figures

Figure 1
Figure 1
Measurement points of head computed tomography at the basal ganglial level. The indicated points were measured in Hounsfield units. Open circles indicate the positioning of the 10-mm2 regions of interest in the cerebral cortex. Open triangles indicate the positioning of the regions of interest in the white matter 1. Square symbols indicate the hallmarks placed to divide the distance from the frontal pole to occipital pole into four equal parts.
Figure 2
Figure 2
Hounsfield units (HU) of the cerebral cortex (left) and white matter 1 (right) of 4 the groups. There were no significant intergroup differences in the HU values of the white matter 1 among these groups. C, Control. †P < 0.001 vs C and GOS 5 groups, **P < 0.01 vs C and GOS 5 groups, ††P < 0.001 vs GOS 1 group.
Figure 3
Figure 3
Differences between the cerebral cortex and white matter 1 (DCW) values among the groups. The DCW values on the Y axis gradually decreased in accordance with worsening of neurological outcome. Box and whisker plots with median, lower and upper quartiles, and outliers are shown. C, Control. †P < 0.001 vs C and GOS 5 groups, **P < 0.01 vs C and GOS 5 groups, ††P < 0.001 vs GOS 1 group, *P < 0.001 vs GOS 2 group.
See this image and copyright information in PMC

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