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Regional Brain Net Water Uptake in Computed Tomography after Cardiac Arrest – A Novel Biomarker for Neuroprognostication

Kenda, Martin ; Lang, Margareta LU ; Nee, Jens ; Hinrichs, Carl ; Dell'Orco, Andrea ; Salih, Farid ; Kemmling, André ; Nielsen, Niklas LU ; Wise, Matt and Thomas, Matthew , et al. (2024) In Resuscitation 200.
Abstract

Background: Selective water uptake by neurons and glial cells and subsequent brain tissue oedema are key pathophysiological processes of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA). Although brain computed tomography (CT) is widely used to assess the severity of HIE, changes of brain radiodensity over time have not been investigated. These could be used to quantify regional brain net water uptake (NWU), a potential prognostic biomarker. Methods: We conducted an observational prognostic accuracy study including a derivation (single center cardiac arrest registry) and a validation (international multicenter TTM2 trial) cohort. Early (<6 h) and follow-up (>24 h) head CTs of CA patients were used to determine... (More)

Background: Selective water uptake by neurons and glial cells and subsequent brain tissue oedema are key pathophysiological processes of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA). Although brain computed tomography (CT) is widely used to assess the severity of HIE, changes of brain radiodensity over time have not been investigated. These could be used to quantify regional brain net water uptake (NWU), a potential prognostic biomarker. Methods: We conducted an observational prognostic accuracy study including a derivation (single center cardiac arrest registry) and a validation (international multicenter TTM2 trial) cohort. Early (<6 h) and follow-up (>24 h) head CTs of CA patients were used to determine regional NWU for grey and white matter regions after co-registration with a brain atlas. Neurological outcome was dichotomized as good versus poor using the Cerebral Performance Category Scale (CPC) in the derivation cohort and Modified Rankin Scale (mRS) in the validation cohort. Results: We included 115 patients (81 derivation, 34 validation) with out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA). Regional brain water content remained unchanged in patients with good outcome. In patients with poor neurological outcome, we found considerable regional water uptake with the strongest effect in the basal ganglia. NWU >8% in the putamen and caudate nucleus predicted poor outcome with 100% specificity (95%-CI: 86–100%) and 43% (moderate) sensitivity (95%-CI: 31–56%). Conclusion: This pilot study indicates that NWU derived from serial head CTs is a promising novel biomarker for outcome prediction after CA. NWU >8% in basal ganglia grey matter regions predicted poor outcome while absence of NWU indicated good outcome. NWU and follow-up CTs should be investigated in larger, prospective trials with standardized CT acquisition protocols.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Automated Image Analysis, Brain Imaging, Cardiac Arrest, Computed Tomography, Edema, Resuscitation, Water Uptake
in
Resuscitation
volume
200
article number
110243
publisher
Elsevier
external identifiers
  • pmid:38796092
  • scopus:85194462632
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2024.110243
language
English
LU publication?
yes
id
de5bc732-232a-43c9-b94c-1169cb332af5
date added to LUP
2024-07-23 14:34:13
date last changed
2024-07-23 14:35:25
@article{de5bc732-232a-43c9-b94c-1169cb332af5,
  abstract     = {{<p>Background: Selective water uptake by neurons and glial cells and subsequent brain tissue oedema are key pathophysiological processes of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA). Although brain computed tomography (CT) is widely used to assess the severity of HIE, changes of brain radiodensity over time have not been investigated. These could be used to quantify regional brain net water uptake (NWU), a potential prognostic biomarker. Methods: We conducted an observational prognostic accuracy study including a derivation (single center cardiac arrest registry) and a validation (international multicenter TTM2 trial) cohort. Early (&lt;6 h) and follow-up (&gt;24 h) head CTs of CA patients were used to determine regional NWU for grey and white matter regions after co-registration with a brain atlas. Neurological outcome was dichotomized as good versus poor using the Cerebral Performance Category Scale (CPC) in the derivation cohort and Modified Rankin Scale (mRS) in the validation cohort. Results: We included 115 patients (81 derivation, 34 validation) with out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA). Regional brain water content remained unchanged in patients with good outcome. In patients with poor neurological outcome, we found considerable regional water uptake with the strongest effect in the basal ganglia. NWU &gt;8% in the putamen and caudate nucleus predicted poor outcome with 100% specificity (95%-CI: 86–100%) and 43% (moderate) sensitivity (95%-CI: 31–56%). Conclusion: This pilot study indicates that NWU derived from serial head CTs is a promising novel biomarker for outcome prediction after CA. NWU &gt;8% in basal ganglia grey matter regions predicted poor outcome while absence of NWU indicated good outcome. NWU and follow-up CTs should be investigated in larger, prospective trials with standardized CT acquisition protocols.</p>}},
  author       = {{Kenda, Martin and Lang, Margareta and Nee, Jens and Hinrichs, Carl and Dell'Orco, Andrea and Salih, Farid and Kemmling, André and Nielsen, Niklas and Wise, Matt and Thomas, Matthew and Düring, Joachim and McGuigan, Peter and Cronberg, Tobias and Scheel, Michael and Moseby-Knappe, Marion and Leithner, Christoph}},
  issn         = {{0300-9572}},
  keywords     = {{Automated Image Analysis; Brain Imaging; Cardiac Arrest; Computed Tomography; Edema; Resuscitation; Water Uptake}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Regional Brain Net Water Uptake in Computed Tomography after Cardiac Arrest – A Novel Biomarker for Neuroprognostication}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2024.110243}},
  doi          = {{10.1016/j.resuscitation.2024.110243}},
  volume       = {{200}},
  year         = {{2024}},
}