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Observational Study
. 2024 Mar:196:110128.
doi: 10.1016/j.resuscitation.2024.110128. Epub 2024 Jan 26.

Association between ASL MRI-derived cerebral blood flow and outcomes after pediatric cardiac arrest

Matthew P Kirschen  1 , Minhui Ouyang  2 , Bhavesh Patel  3 , Jeffrey I Berman  2 , Ryan Burnett  3 , Robert A Berg  3 , Ramon Diaz-Arrastia  4 , Alexis Topjian  3 , Hao Huang  4 , Arastoo Vossough  2
Affiliations
Observational Study

Association between ASL MRI-derived cerebral blood flow and outcomes after pediatric cardiac arrest

Matthew P Kirschen et al. Resuscitation. 2024 Mar.

Abstract

Aim: Cerebral blood flow (CBF) is dysregulated after cardiac arrest. It is unknown if post-arrest CBF is associated with outcome. We aimed to determine the association of CBF derived from arterial spin labelling (ASL) MRI with outcome after pediatric cardiac arrest.

Methods: Retrospective observational study of patients ≤18 years who had a clinically obtained brain MRI within 7 days of cardiac arrest between June 2005 and December 2019. Primary outcome was unfavorable neurologic status: change in Pediatric Cerebral Performance Category (PCPC) ≥1 from pre-arrest that resulted in hospital discharge PCPC 3-6. We measured CBF in whole brain and regions of interest (ROIs) including frontal, parietal, and temporal cortex, caudate, putamen, thalamus, and brainstem using pulsed ASL. We compared CBF between outcome groups using Wilcoxon Rank-Sum and performed logistic regression to associate each region's CBF with outcome, accounting for age, sex, and time between arrest and MRI.

Results: Forty-eight patients were analyzed (median age 2.8 [IQR 0.95, 8.8] years, 65% male). Sixty-nine percent had unfavorable outcome. Time from arrest to MRI was 4 [3,5] days and similar between outcome groups (p = 0.39). Whole brain median CBF was greater for unfavorable compared to favorable groups (28.3 [20.9,33.0] vs. 19.6 [15.3,23.1] ml/100 g/min, p = 0.007), as was CBF in individual ROIs. Greater CBF in the whole brain and individual ROIs was associated with higher odds of unfavorable outcome after controlling for age, sex, and days from arrest to MRI (aOR for whole brain 19.08 [95% CI 1.94, 187.41]).

Conclusion: CBF measured 3-5 days after pediatric cardiac arrest by ASL MRI was independently associated with unfavorable outcome.

Keywords: Arterial spin labeling; MRI; Neuroimaging; Pediatric cardiac arrest.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Kirschen received NIH support to his institution. The remaining authors have no declarations of interest.

Figures

Figure 1:
Figure 1:
Cerebral blood flow (CBF) maps in a representative patient with a favorable (top) and an unfavorable (bottom) outcome. Brighter colors indicate higher CBF. In this example, the patient with an unfavorable outcome, has increased CBF in both the cortex and deeper brain structures compared to the patient with a favorable outcome. CBF was measured in milliliters of blood per minute per 100g brain tissue (ml/100g/min). rCBF: regional cerebral blood flow.
Figure 2:
Figure 2:
Cerebral blood flow (CBF) in patients with favorable (black) and unfavorable (white) outcomes in the whole brain and bilateral regions of interest (ROIs). CBF is measured in mL/100g of brain tissue/minute (ml/100g/min) and plotted as medians with IQRs. * p<0.05.
Figure 3:
Figure 3:
Unadjusted and adjusted odds ratios (95% confidence intervals) for unfavorable outcome. Odds ratios represent “per 1 log increase” of each variable.
See this image and copyright information in PMC

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