Patterns of MRI Brain Injury in Children after Out-of-Hospital Cardiac Arrest.
Publication/Presentation Date
10-24-2025
Abstract
BACKGROUND AND PURPOSE: Pediatric out-of-hospital cardiac arrest (OHCA) is associated with significant morbidity and mortality from hypoxic-ischemic brain injury. The patterns and evolution of brain injury on MRI following pediatric OHCA have not been well described. The purpose of this study was to evaluate regional brain injury patterns on MRI following pediatric OHCA and its association with clinical factors.
MATERIALS AND METHODS: We analyzed a retrospective cohort of pediatric patients aged between 48 hours to 18 years who experienced OHCA between 2016-2023 and underwent brain MRI containing DWI and T2-weighted sequences within 8 days post-arrest. Two neuroradiologists independently scored the presence or absence of signal abnormality in the cortex, white matter (WM), globus pallidus, putamen/caudate, thalamus, posterior limb of the internal capsule (PLIC), hippocampus, brainstem, and cerebellum.
RESULTS: Of the 68 patients included, 46 (68%) exhibited brain injury on initial MRI, with the most common locations being the cortex (50%), putamen/caudate (43%), and WM (40%). First MRI was obtained at a median of 3 (IQR 1-4) days post-arrest. Patients with WM injury were younger (median age 1.4 years) than those without WM injury (3.6 years, P=0.01), and those with PLIC injury were younger (median age 0.4 years) than those without PLIC injury (3.5 years, P=0.003). Longer time to ROSC was associated with injury across a greater number of brain regions (P< 0.001). Among 11 patients who underwent two MRIs within 8 days, WM injury occurred more frequently on later imaging (36% on first MRI versus 73% on second MRI, P< 0.05).
CONCLUSIONS: Patterns of injury after pediatric OHCA are influenced by patient age, timing of imaging, and cardiac arrest characteristics. The evolving distribution of injury, such as delayed appearance of WM injury, and greater vulnerability of WM and PLIC in younger patients highlight the importance of considering clinical context when interpreting post-arrest brain MRI. Recognizing these patterns may aid in identifying hypoxic-ischemic injury, especially when clinical history is limited.
ABBREVIATIONS: OHCA = out-of-hospital cardiac arrest; CPR = cardiopulmonary resuscitation; ROSC = return of spontaneous circulation; WM = white matter; PLIC = posterior limb of the internal capsule; ICH = intracranial hemorrhage.
ISSN
1936-959X
Published In/Presented At
Shih, J. J., Baker, A., Vassar, R., Mehta, N., Wietstock, S. O., Amorim, E., George, E., Lindan, C., Glenn, O., Hetts, S. W., Martin, M., McCulloch, C. E., Xu, D., & Li, Y. (2025). Patterns of MRI Brain Injury in Children after Out-of-Hospital Cardiac Arrest. AJNR. American journal of neuroradiology, ajnr.A9057. Advance online publication. https://doi.org/10.3174/ajnr.A9057
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
41136331
Department(s)
Department of Pediatrics
Document Type
Article