Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

  • Kim, Min Jeong (Department of Radiology, Ewha Womans University College of Medicine) ;
  • Park, Yae Won (Department of Radiology, Ewha Womans University College of Medicine) ;
  • Lim, Soo Mee (Department of Radiology, Ewha Womans University College of Medicine)
  • Received : 2017.10.25
  • Accepted : 2017.12.12
  • Published : 2018.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Therapeutic hypothermia in cardiac arrest patients is associated with favorable outcomes mediated via neuroprotective mechanisms. We report a rare case of a 32-year-old male who demonstrated complete recovery of signal changes on perfusion-weighted imaging after therapeutic hypothermia due to cardiac arrest. Brain MRI with perfusion-weighted imaging, performed three days after ending the hypothermia therapy, showed a marked decrease in relative cerebral blood flow (rCBF) and delay in mean transit time (MTT) in the bilateral basal ganglia, thalami, brain stem, cerebellum, occipitoparietal cortex, and frontotemporal cortex. However, no cerebral ischemia was not noted on diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR) sequences. A follow-up brain MRI after one week showed complete resolution of the perfusion deficit and the patient was discharged without any neurologic sequelae. The mechanism and interpretation of the perfusion changes in cardiac arrest patients treated with therapeutic hypothermia are discussed.

Keywords

References

  1. Holzer M, Bernard SA, Hachimi-Idrissi S, et al. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med 2005;33:414-418
  2. Li F, Liu KF, Silva MD, et al. Acute postischemic renormalization of the apparent diffusion coefficient of water is not associated with reversal of astrocytic swelling and neuronal shrinkage in rats. AJNR Am J Neuroradiol 2002;23:180-188
  3. Jarnum H, Knutsson L, Rundgren M, et al. Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: a prospective observational study. Resuscitation 2009;80:425-430 https://doi.org/10.1016/j.resuscitation.2009.01.004
  4. Liu R, Li X, Hu CL, et al. The changes of brain water diffusion and blood flow on diffusion-weighted and perfusion-weighted imaging in a canine model of cardiac arrest. Resuscitation 2012;83:645-651 https://doi.org/10.1016/j.resuscitation.2011.10.017
  5. Youn CS, Park KN, Kim JY, et al. Repeated diffusion weighted imaging in comatose cardiac arrest patients with therapeutic hypothermia. Resuscitation 2015;96:1-8
  6. Keller E, Steiner T, Fandino J, Schwab S, Hacke W. Changes in cerebral blood flow and oxygen metabolism during moderate hypothermia in patients with severe middle cerebral artery infarction. Neurosurg Focus 2000;8:e4
  7. Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics 2008;28:417-439; quiz 617 https://doi.org/10.1148/rg.282075066