Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices,Pediatric Neurology

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Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices
Pediatric Neurology ( IF 3.2 ) Pub Date : 2022-06-20 , DOI: 10.1016/j.pediatrneurol.2022.06.011
Juan A Piantino ₁ , Christopher M Ruzas ₂ , Craig A Press ₃ , Subramanian Subramanian ₄ , Binod Balakrishnan ₅ , Ashok Panigrahy ₄ , David Pettersson ₆ , John A Maloney ₇ , Arastoo Vossough ₈ , Alexis Topjian ₉ , Matthew P Kirschen ₉ , Lesley Doughty ₁₀ , Melissa G Chung ₁₁ , David Maloney ₁₂ , Tamara Haller ₁₃ , Anthony Fabio ₁₃ , Ericka L Fink ₁₂ ,

Affiliation

Division of Child Neurology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
Division of Neurology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Neuroradiology, Department of Diagnostic Radiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.

Background

Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA.

Methods

A survey was distributed to pediatric institutions participating in three international studies. Survey questions related to center demographics, clinical practice patterns of MRI after CA, neuroimaging resources, and details regarding MRI decision support.

Results

Response rate was 31% (44 of 143). Thirty-four percent (15 of 44) of centers have a clinical pathway informing the use of MRI after CA. Fifty percent (22 of 44) of respondents reported that an MRI is obtained in nearly all patients with CA, and 32% (14 of 44) obtain an MRI in those who do not return to baseline neurological status. Poor neurological examination was reported as the most common factor (91% [40 of 44]) determining the timing of the MRI. Conventional sequences (T1, T2, fluid-attenuated inversion recovery, and diffusion-weighted imaging/apparent diffusion coefficient) are routinely used at greater than 97% of centers. Use of advanced imaging techniques (magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI) were reported by less than half of centers.

Conclusions

Conventional brain MRI is a common practice for prognostication after CA. Advanced imaging techniques are used infrequently. The lack of standardized clinical pathways and variability in reported practices support a need for higher-quality evidence regarding the indications, timing, and acquisition protocols of clinical MRI studies.

中文翻译：

磁共振成像在小儿心脏骤停后神经预测中的应用：当前实践的调查

背景

已经描述了使用磁共振成像（MRI）作为心脏骤停（CA）后辅助神经预测的工具，但具体适应症、时间和顺序的细节尚不清楚。我们的目标是确定当前使用脑 MRI 进行儿科 CA 预后的实践。

方法

一项调查已分发给参与三项国际研究的儿科机构。调查问题涉及中心人口统计、CA 后 MRI 的临床实践模式、神经影像资源以及有关 MRI 决策支持的详细信息。

结果

回应率为 31%（143 人中的 44 人）。 34%（44 个中心中的 15 个）有临床路径，告知 CA 后使用 MRI。 50%（44 人中的 22 人）的受访者表示，几乎所有 CA 患者都进行了 MRI 扫描，32%（44 人中的 14 人）对那些未恢复到基线神经系统状态的患者进行了 MRI 扫描。据报道，神经系统检查不良是决定 MRI 时机的最常见因素（91% [44 中的 40]）。超过 97% 的中心常规使用传统序列（T1、T2、流体衰减反转恢复和扩散加权成像/表观扩散系数）。不到一半的中心报告使用了先进的成像技术（磁共振波谱、扩散张量成像和功能性 MRI）。