Utility of white matter to gray matter signal intensity ratio in comatose patients treated by targeted temperature management after cardiac arrest: a preliminary study

Keum, Kyoung Tak; Kim, Yong Hwan; Hwang, Seong Youn; Lee, Jun Ho; Lee, Dong Woo; Song, Yun Gyu; Lee, Jung Hwa; Lee, Kyoung Yul

J Korean Soc Emerg Med > Volume 30(5); 2019 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2019;30(5): 437-445.

목표 체온 조절 치료를 받은 심정지 환자에서의 예후 평가 도구로서 뇌 MRI T2 weighted image에서의 회색질과 백색질 신호 강도 비의 유용성: 선행연구

금경탁¹

, 김용환¹

, 황성연¹

, 이준호¹

, 이동우¹, 송윤규², 이정화³, 이경렬⁴

¹성균관대학교 의과대학 삼성창원병원 응급의학과
²성균관대학교 의과대학 삼성창원병원 영상의학과
³이화여자대학교 목동병원 신경과학교실 응급중환자진료과
⁴경남대학교 체육교육과

Utility of white matter to gray matter signal intensity ratio in comatose patients treated by targeted temperature management after cardiac arrest: a preliminary study

, Dong Woo Lee¹, Yun Gyu Song², Jung Hwa Lee³, Kyoung Yul Lee⁴

¹Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
²Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
³Department of Neurology and Critical Care Medicine, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
⁴Department of Physical Education, Kyungnam University, Changwon, Korea

Correspondence

Yong Hwan Kim ,Tel: 055-233-6053, Fax: 055-233-6134, Email: suka1212@naver.com,

Received: April 17, 2019; Revised: June 15, 2019 Accepted: July 1, 2019. Published online: October 31, 2019.

ABSTRACT

Objective:
This study examined the efficacy of the white matter (WM) to gray matter (GM) signal intensity ratio (SIR) in predicting the clinical prognosis of cardiac arrest patients.
Method:
Thirty-one patients who were resuscitated from cardiac arrest and underwent brain magnetic resonance imaging (MRI) were investigated retrospectively. Thirty one subjects with normal brain MRI findings served as the controls. The signal intensities (SI) were measured on T2-weighted image (T2WI). The circular regions of measurement (2-10 mm2) were placed over the regions of interest, and the average signals in GM and WM were recorded in the caudate nucleus (CN), putamen, anterior limb of the internal capsule, corpus callosum (CC), and in the cortex and WM of the frontal lobe. Cerebral performance category (CPC) 1-2 were classified as a good prognosis, and CPC 3-5 were classified as a poor prognosis.
Results:
Most combinations of the SIR of WM to GM and most SIs of GM, except the frontal cortex, were significantly different between the two groups. On the other hand, the SI of WM was insignificant between both groups. In receiver operating characteristic (ROC) curve analysis, the SIR of the CC to CN had an area under the ROC curve (AUROC) of 1.00 for a cut-off value of 1.59 (sensitivity, 100%; specificity, 100%), the SIR of the CC to putamen had also an AUROC of 1.00 for a cut-off value of 1.43 (sensitivity, 100%; specificity, 100%).
Conclusion:
The SIR of WM to GM measured on a T2WI is related to the neurological outcome after a cardiac arrest.

Key words: Cardiac arrest; Magnetic resonance imaging; Prognosis; Signal intensity