Brain Gray Matter MRI Morphometry for Neuroprognostication After Cardiac Arrest

Stein Silva (1) , Patrice Péran (2) , Lionel Kerhuel , Briguita Malagurski , Nicolas Chauveau (3) , Benoît Bataille (4) , Jean Albert Lotterie , Pierre Celsis (5) , Florent Aubry (5) , Giuseppe Citerio (6) , Betty Jean (7) , Russel Chabanne (7) , Vincent Perlbarg (8) , Lionel Velly (9) , Damien Galanaud (10) , Audrey Vanhaudenhuyse (11) , Olivier Fourcade (1) , Steven Laureys (12) , Louis Puybasset (13)

1 Pôle Anesthésie Réanimation [CHU de Toulouse]
2 ToNIC - Toulouse NeuroImaging Center
3 INSERM - Institut National de la Santé et de la Recherche Médicale
4 Service de neurologie [Poitiers]
5 Neuro-Imagerie Fonctionnelle, Plasticite Cerebrale et Pathologie Neurologique
6 Neurointensive Care Unit
7 CHU Clermont-Ferrand
8 LIB - Laboratoire d'Imagerie Biomédicale [Paris]
9 APHM - Assistance Publique - Hôpitaux de Marseille
10 CHU Pitié-Salpêtrière [AP-HP]
11 CRC - Centre de Recherches du Cyclotron [Liège]
12 Coma Science Group [Liege]
13 Johns Hopkins University School of Medicine [Baltimore]

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), Liege (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.

Mots clés: cardiac arrest; comacortical thickness; prognosis; subcortical volumetry

Domaines: Neurosciences; Neurosciences [q-bio.NC]

Stein Silva, Patrice Péran, Lionel Kerhuel, Briguita Malagurski, Nicolas Chauveau, et al.. Brain Gray Matter MRI Morphometry for Neuroprognostication After Cardiac Arrest. Critical Care Medicine, 2017, 45 (8), pp.e763-e771. ⟨10.1097/CCM.0000000000002379⟩. ⟨hal-02013552⟩