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Computed tomography grey-white matter ratio at the basal ganglia level in a reference population for hypoxic ischaemic encephalopathy after cardiac arrest – A cross-sectional observational study

Lang, Margareta LU ; Kenda, Martin ; Johnsson, Mikael ; Leithner, Christoph ; Cronberg, Tobias LU ; Ullén, Susann LU ; Moseby-Knappe, Marion LU ; Nielsen, Niklas LU orcid and Wassélius, Johan LU (2025) In Resuscitation
Abstract

Introduction: A grey-white matter ratio (GWR) < 1.10 at the basal ganglia level on head computed tomography (CT) previously predicted poor outcome with high specificity and moderate sensitivity in cardiac arrest patients. Data on GWR in reference populations are lacking. We explored GWR in a reference group to a cardiac arrest population and hypothesised that none would have GWR < 1.10. Methods: A retrospective cross-sectional single-centre study. Patients with CT for suspected stroke or transient ischaemic attack were screened between January–August 2021 and included based on matching age and sex to cardiac arrest populations. CTs with pathologic findings were excluded. Circular regions of interest (ROIs) of 0.1 and 0.2... (More)

Introduction: A grey-white matter ratio (GWR) < 1.10 at the basal ganglia level on head computed tomography (CT) previously predicted poor outcome with high specificity and moderate sensitivity in cardiac arrest patients. Data on GWR in reference populations are lacking. We explored GWR in a reference group to a cardiac arrest population and hypothesised that none would have GWR < 1.10. Methods: A retrospective cross-sectional single-centre study. Patients with CT for suspected stroke or transient ischaemic attack were screened between January–August 2021 and included based on matching age and sex to cardiac arrest populations. CTs with pathologic findings were excluded. Circular regions of interest (ROIs) of 0.1 and 0.2 cm2 were placed by three raters at the basal ganglia level and GWR was calculated. Bland-Altman plots estimated interrater variability of GWR from 0.1 and 0.2 cm2 ROIs. Results: 155 participants were included. The mean age was 75 years, and 59 % were male. No measurement resulted in GWR < 1.10. Median GWR for all raters ranged between 1.30–1.32 in 0.1 cm2 ROIs and 1.27–1.32 in 0.2 cm2 ROIs. The lower and upper limits of agreement between raters were around 0.1. The 0.2 cm2 ROIs GWR achieved smaller limits of agreement compared to the 0.1 cm2 ROIs GWR. Attenuation measurements and GWR differed depending on ROI size used. Conclusion: A GWR at the basal ganglia level below 1.10 is very unlikely in elderly patients without HIE, suggesting that this may provide a relevant cut-off for HIE prognostication in cardiac arrest patients.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Computed tomography, CT, Grey-white matter ratio, GWR, HIE, Hypoxic-ischaemic encephalopathy, Prognostication
in
Resuscitation
article number
110705
publisher
Elsevier
external identifiers
  • pmid:40619058
  • scopus:105011053771
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2025.110705
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s)
id
2044f45c-f819-452c-a1cd-c4239e271ad8
date added to LUP
2026-01-12 13:09:20
date last changed
2026-01-12 13:10:40
@article{2044f45c-f819-452c-a1cd-c4239e271ad8,
  abstract     = {{<p>Introduction: A grey-white matter ratio (GWR) &lt; 1.10 at the basal ganglia level on head computed tomography (CT) previously predicted poor outcome with high specificity and moderate sensitivity in cardiac arrest patients. Data on GWR in reference populations are lacking. We explored GWR in a reference group to a cardiac arrest population and hypothesised that none would have GWR &lt; 1.10. Methods: A retrospective cross-sectional single-centre study. Patients with CT for suspected stroke or transient ischaemic attack were screened between January–August 2021 and included based on matching age and sex to cardiac arrest populations. CTs with pathologic findings were excluded. Circular regions of interest (ROIs) of 0.1 and 0.2 cm<sup>2</sup> were placed by three raters at the basal ganglia level and GWR was calculated. Bland-Altman plots estimated interrater variability of GWR from 0.1 and 0.2 cm<sup>2</sup> ROIs. Results: 155 participants were included. The mean age was 75 years, and 59 % were male. No measurement resulted in GWR &lt; 1.10. Median GWR for all raters ranged between 1.30–1.32 in 0.1 cm<sup>2</sup> ROIs and 1.27–1.32 in 0.2 cm<sup>2</sup> ROIs. The lower and upper limits of agreement between raters were around 0.1. The 0.2 cm<sup>2</sup> ROIs GWR achieved smaller limits of agreement compared to the 0.1 cm<sup>2</sup> ROIs GWR. Attenuation measurements and GWR differed depending on ROI size used. Conclusion: A GWR at the basal ganglia level below 1.10 is very unlikely in elderly patients without HIE, suggesting that this may provide a relevant cut-off for HIE prognostication in cardiac arrest patients.</p>}},
  author       = {{Lang, Margareta and Kenda, Martin and Johnsson, Mikael and Leithner, Christoph and Cronberg, Tobias and Ullén, Susann and Moseby-Knappe, Marion and Nielsen, Niklas and Wassélius, Johan}},
  issn         = {{0300-9572}},
  keywords     = {{Cardiac arrest; Computed tomography; CT; Grey-white matter ratio; GWR; HIE; Hypoxic-ischaemic encephalopathy; Prognostication}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Computed tomography grey-white matter ratio at the basal ganglia level in a reference population for hypoxic ischaemic encephalopathy after cardiac arrest – A cross-sectional observational study}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2025.110705}},
  doi          = {{10.1016/j.resuscitation.2025.110705}},
  year         = {{2025}},
}