Acute cardiac care & resuscitation
Brain MRI–based prognostication after cardiac arrest: qualitative assessment outperforms variable voxel-wise apparent diffusion coefficient (ADC) thresholds
Authors' conclusion
Qualitative visual assessment remained a robust predictor, both independently and as part of multimodal prognostication, whereas quantitative ADC thresholds showed substantial variability across aetiologies and MRI protocols, underscoring the limitations of a universal threshold.
Study context
- Population
- Comatose patients resuscitated after cardiac arrest and treated with targeted temperature management, single tertiary care centre
- Participants
- 261 patients
- Comparison
- Voxel-wise ADC thresholds vs qualitative visual MRI assessment
- Outcome
- Poor neurological outcome (Cerebral Performance Category 3-5)
Methodological detailssingle-centre, cohort
- Single-centre
- Cohort
Performance
As reported in the abstract
Prediction of poor neurological outcome
| Test or model | AUC | PV 450 >3.1 %: sensitivity | PV 450 >11.8 %: sensitivity | Sensitivity | PV 450 >3.1 %: specificity | PV 450 >11.8 %: specificity | Specificity |
|---|---|---|---|---|---|---|---|
| PV 400/450 | 0.86 [95 % CI, 0.82-0.90] | 68.6 % | 40.6 % | Not reported in the abstract | 96.5 % | 100.0 % | Not reported in the abstract |
| Qualitative visual MRI assessment | 0.91 [95 % CI, 0.88-0.93] | Not reported in the abstract | Not reported in the abstract | 81.1 % | Not reported in the abstract | Not reported in the abstract | 100 % |
AUC
PV 400/4500.86 [95 % CI, 0.82-0.90]
Qualitative visual MRI assessment0.91 [95 % CI, 0.88-0.93]
PV 450 >3.1 %: sensitivity
PV 400/45068.6 %
Qualitative visual MRI assessmentNot reported in the abstract
PV 450 >11.8 %: sensitivity
PV 400/45040.6 %
Qualitative visual MRI assessmentNot reported in the abstract
Sensitivity
PV 400/450Not reported in the abstract
Qualitative visual MRI assessment81.1 %
PV 450 >3.1 %: specificity
PV 400/45096.5 %
Qualitative visual MRI assessmentNot reported in the abstract
PV 450 >11.8 %: specificity
PV 400/450100.0 %
Qualitative visual MRI assessmentNot reported in the abstract
Specificity
PV 400/450Not reported in the abstract
Qualitative visual MRI assessment100 %
Further findings
Combination with other modalities
- Qualitative assessment had the highest sensitivity and 100 % specificity combined with other modalities
AUC by arrest aetiology (subgroup)
- Cardiac aetiology: highest AUC at PV 400
- 0.85 [95 % CI 0.79-0.91]
- Non-cardiac aetiology: PV 500 and adjacent thresholds (PV 450-550) peak AUC
- 0.89 [95 % CI, 0.83-0.95]
Scanning protocol change (DTI-based, 12 directions)
- Shifted ADC distributions upward without altering other brain injury markers
Original publication
Brain MRI–based prognostication after cardiac arrest: qualitative assessment outperforms variable voxel-wise ADC thresholds. Resuscitation. Published 22 December 2025. doi:10.
Summarised from the published abstract; every number is checked against it