Repeated diffusion weighted imaging in comatose cardiac arrest patients with therapeutic hypothermia

Background: The aim of this study was to evaluate the changing pattern and prognostic values of diffusion-weighted imaging (DWI) at two time points in cardiac arrest patients treated with therapeutic hypothermia. Methods: Twenty two patients with cardiac arrest who underwent two DWI studies were enrolled in the retrospective study. The first DWI was performed after the induction of therapeutic hypothermia (median 6.0 h) and was repeated between 48 h and 168 h (second DWI, median 74 h). Apparent diffusion coefficient (ADC) values were measured in the predefined brain regions, and qualitative analysis was also performed. Good neurologic outcomes were defined as Cerebral Performance Category (CPC) scores of 1 and 2. Results: The ADC value tended to increase over time except the cortical regions of the poor outcome group (N= 10). In the comparisons of receiver operating characteristic (ROC) curve to predict poor outcome using ADC value, postcentral cortex in the second DWI has a better association with neurological outcome (p=0.001, area under the curve (AUC) = 0.996 for second DWI, AUC =0.571 for first DWI). In the same analysis using qualitative score, precentral cortex, postcentral cortex, parietal lobe, occipital lobe, caudate and putamen in the second DWI have a better association with neurological outcome. Conclusions: The changing pattern of ADC values after cardiac arrest is different according to anatomic region and neurologic status. The DWI after 48 h has a better association with neurological outcome of cardiac arrest patients in both quantitative and qualitative analysis.