Brain gray matter MRI morphometry for neuroprognostication after cardiac arrest

Article; Belgium; France; Italy; Adult; Brain; Cerebellar Cortex; Coma; Female; Gray Matter; Heart Arrest; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Prospective Studies

Abstract :

[en] Objectives: We hypothesize that the combined use of MRI cortical thickness measurement and subcortical gray matter volumetry could provide an early and accurate in vivo assessment of the structural impact of cardiac arrest and therefore could be used for long-term neuroprognostication in this setting. Design: Prospective cohort study. Setting: Five Intensive Critical Care Units affiliated to the University in Toulouse (France), Paris (France), Clermont-Ferrand (France), Liège (Belgium), and Monza (Italy). Patients: High-resolution anatomical T1-weighted images were acquired in 126 anoxic coma patients ("learning" sample) 16 ± 8 days after cardiac arrest and 70 matched controls. An additional sample of 18 anoxic coma patients, recruited in Toulouse, was used to test predictive model generalization ("test" sample). All patients were followed up 1 year after cardiac arrest. Interventions: None. Measurements and Main Results: Cortical thickness was computed on the whole cortical ribbon, and deep gray matter volumetry was performed after automatic segmentation. Brain morphometric data were employed to create multivariate predictive models using learning machine techniques. Patients displayed significantly extensive cortical and subcortical brain volumes atrophy compared with controls. The accuracy of a predictive classifier, encompassing cortical and subcortical components, has a significant discriminative power (learning area under the curve = 0.87; test area under the curve = 0.96). The anatomical regions which volume changes were significantly related to patient's outcome were frontal cortex, posterior cingulate cortex, thalamus, putamen, pallidum, caudate, hippocampus, and brain stem. Conclusions: These findings are consistent with the hypothesis of pathologic disruption of a striatopallidal-thalamo-cortical mesocircuit induced by cardiac arrest and pave the way for the use of combined brain quantitative morphometry in this setting. Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Disciplines :

Neurology

Author, co-author :

Silva, Stein; Department of Anaesthesiology and Critical Care, Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France, Critical Care and Anaesthesiology Department, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France, Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Peran, Patrice; Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Kerhuel, Lionel; Department of Anaesthesiology and Critical Care, Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France, Critical Care and Anaesthesiology Department, University Teaching Hospital of Purpan, Place du Dr Baylac, Toulouse Cedex 9, France, Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Malagurski, Briguita; Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Chauveau, Nicolas; Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Bataille, Benoit; Department of Anaesthesiology and Critical Care, Critical Care Unit, Hopital Dieu Hospital, Narbonne, France

Lotterie, Jean Albert; Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Celsis, Pierre; Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Aubry, Florent; Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, France

Citerio, Giuseppe; Department of Anaesthesiology and Critical Care, School of Medicine and Surgery, University Milano Bicocca and Hospital San Gerardo, Monza, Italy

More authors (9 more)

Language :

English

Title :

Brain gray matter MRI morphometry for neuroprognostication after cardiac arrest

Publication date :

2017

Journal title :

Critical Care Medicine

ISSN :

0090-3493

eISSN :

1530-0293

Publisher :

Lippincott Williams and Wilkins

Volume :

Issue :

Pages :

e763-e771

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 06 January 2020

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