Acute cardiac care & resuscitation
Radiological signs of hypoxic-ischaemic encephalopathy on head computed tomography for prediction of poor functional outcome after cardiac arrest – a prospective observational cohort study
Authors' conclusion
Extensive and bilateral loss of grey-white matter distinction on CT is associated with poor functional outcome after cardiac arrest and yielded the highest interrater agreement. Signs of sulcal effacement were less reliable and should thus be used with caution in neuroprognostication. The TTM2 CT substudy is registered at clinicaltrials.gov (NCT03913065).
Study context
- Population
- Unconscious patients after out-of-hospital cardiac arrest examined with computed tomography (CT) > 48 h ≤ 7 dayspatients examined with CT
- Participants
- 140 patients
- Exposure
- Radiological items on CT for prediction of poor outcome
- Outcome
- Prediction of poor functional outcome (modified Rankin Scale 4-6)
- Follow-up
- Six months
Methodological detailsprospective sub-study within the TTM2 trial
- Prospective sub-study within the TTM2 trial
Main finding
As reported in the abstract
| Group | Sensitivity | Specificity |
|---|---|---|
| Loss of grey-white matter distinction | 45-50% | 100% |
| Sulcal effacement | 29-49% | 93-99% |
| The Pseudo Subarachnoid Haemorrhage Sign, the Reversal Sign, and the White Cerebellum Sign | 8-11% | 99-100% |
Sensitivity
Loss of grey-white matter distinction45-50%
Sulcal effacement29-49%
The Pseudo Subarachnoid Haemorrhage Sign, the Reversal Sign, and the White Cerebellum Sign8-11%
Specificity
Loss of grey-white matter distinction100%
Sulcal effacement93-99%
The Pseudo Subarachnoid Haemorrhage Sign, the Reversal Sign, and the White Cerebellum Sign99-100%
Observational data: associations, not effects.
Further findings
Interrater agreement
- Highest interrater agreement, "moderate", for loss of grey-white matter distinction at high convexity level
- κ = 0.74
Patient characteristics
- Time of CT post-arrest, median (IQR)
- 84 h (IQR 66-109)
- Median age (IQR)
- 68 years (IQR 59-76)
- Male
- 106 (76%)
- Poor functional outcome
- 105 (75%)
Original publication
Radiological signs of hypoxic-ischaemic encephalopathy on head computed tomography for prediction of poor functional outcome after cardiac arrest – a prospective observational cohort study. Resuscitation. Published 9 June 2025. doi:10.
Summarised from the published abstract; every number is checked against it