Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study

Margareta Lang; Martin Kenda; Michael Scheel; Juha Martola; Matthew Wheeler; Stephanie Owen; Mikael Johnsson; Martin Annborn; Josef Dankiewicz; Nicolas Deye; Joachim Düring; Hans Friberg; Thomas Halliday; Janus Christian Jakobsen; Jean-Baptiste Lascarrou; Helena Levin; Gisela Lilja; Anna Lybeck; Peter McGuigan; Christian Rylander; Victoria Sem; Matthew Thomas; Susann Ullén; Johan Undén; Matt P Wise; Tobias Cronberg; Johan Wassélius; Niklas Nielsen; Christoph Leithner; Marion Moseby-Knappe

doi:10.1007/s00134-024-07497-2

Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study

Margareta Lang, Martin Kenda, Michael Scheel, Juha Martola, Matthew Wheeler, Stephanie Owen, Mikael Johnsson, Martin Annborn, Josef Dankiewicz, Nicolas Deye, Joachim Düring, Hans Friberg, Thomas Halliday, Janus Christian Jakobsen, Jean-Baptiste Lascarrou, Helena Levin, Gisela Lilja, Anna Lybeck, Peter McGuigan, Christian RylanderVictoria Sem, Matthew Thomas, Susann Ullén, Johan Undén, Matt P Wise, Tobias Cronberg, Johan Wassélius, Niklas Nielsen, Christoph Leithner, Marion Moseby-Knappe^*

^*Corresponding author for this work

Copenhagen Trial Unit

20 Citations (Scopus)

Abstract

PURPOSE: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest.

METHODS: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey-white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4-6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated.

RESULTS: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59-76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90-100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77-0.91) did not significantly differ from manually obtained GWR.

CONCLUSION: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.

Original language	English
Journal	Intensive Care Medicine
Volume	50
Issue number	7
Pages (from-to)	1096-1107
Number of pages	12
ISSN	0342-4642
DOIs	https://doi.org/10.1007/s00134-024-07497-2
Publication status	Published - Jul 2024

Keywords

Aged
Female
Head/diagnostic imaging
Humans
Hypothermia, Induced/methods
Male
Middle Aged
Out-of-Hospital Cardiac Arrest/therapy
Predictive Value of Tests
Prognosis
Prospective Studies
Tomography, X-Ray Computed/methods
GWR
Hypoxic–ischaemic encephalopathy
Cardiac arrest
Computed tomography

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Lang, M., Kenda, M., Scheel, M., Martola, J., Wheeler, M., Owen, S., Johnsson, M., Annborn, M., Dankiewicz, J., Deye, N., Düring, J., Friberg, H., Halliday, T., Jakobsen, J. C., Lascarrou, J.-B., Levin, H., Lilja, G., Lybeck, A., McGuigan, P., ... Moseby-Knappe, M. (2024). Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study. Intensive Care Medicine, 50(7), 1096-1107. https://doi.org/10.1007/s00134-024-07497-2

Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study. / Lang, Margareta; Kenda, Martin; Scheel, Michael et al.
In: Intensive Care Medicine, Vol. 50, No. 7, 07.2024, p. 1096-1107.

Research output: Contribution to journal › Journal article › Research › peer-review

Lang, M, Kenda, M, Scheel, M, Martola, J, Wheeler, M, Owen, S, Johnsson, M, Annborn, M, Dankiewicz, J, Deye, N, Düring, J, Friberg, H, Halliday, T, Jakobsen, JC, Lascarrou, J-B, Levin, H, Lilja, G, Lybeck, A, McGuigan, P, Rylander, C, Sem, V, Thomas, M, Ullén, S, Undén, J, Wise, MP, Cronberg, T, Wassélius, J, Nielsen, N, Leithner, C & Moseby-Knappe, M 2024, 'Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study', Intensive Care Medicine, vol. 50, no. 7, pp. 1096-1107. https://doi.org/10.1007/s00134-024-07497-2

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title = "Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study",

abstract = "PURPOSE: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest.METHODS: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey-white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4-6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated.RESULTS: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59-76), 76\% were male, and 75\% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100\% specificity (95\% confidence interval [CI] 90-100). Sensitivity in median was 37\% for the standardised qualitative assessment, 39\% for GWR-8, 30\% for GWR-4 and 41\% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95\% CI 0.77-0.91) did not significantly differ from manually obtained GWR.CONCLUSION: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.",

keywords = "Aged, Female, Head/diagnostic imaging, Humans, Hypothermia, Induced/methods, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/therapy, Predictive Value of Tests, Prognosis, Prospective Studies, Tomography, X-Ray Computed/methods, GWR, Hypoxic–ischaemic encephalopathy, Cardiac arrest, Computed tomography",

author = "Margareta Lang and Martin Kenda and Michael Scheel and Juha Martola and Matthew Wheeler and Stephanie Owen and Mikael Johnsson and Martin Annborn and Josef Dankiewicz and Nicolas Deye and Joachim D{\"u}ring and Hans Friberg and Thomas Halliday and Jakobsen, \{Janus Christian\} and Jean-Baptiste Lascarrou and Helena Levin and Gisela Lilja and Anna Lybeck and Peter McGuigan and Christian Rylander and Victoria Sem and Matthew Thomas and Susann Ull{\'e}n and Johan Und{\'e}n and Wise, \{Matt P\} and Tobias Cronberg and Johan Wass{\'e}lius and Niklas Nielsen and Christoph Leithner and Marion Moseby-Knappe",

note = "{\textcopyright} 2024. The Author(s).",

year = "2024",

month = jul,

doi = "10.1007/s00134-024-07497-2",

language = "English",

volume = "50",

pages = "1096--1107",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "7",

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TY - JOUR

T1 - Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest

T2 - a prospective multicentre study

AU - Lang, Margareta

AU - Kenda, Martin

AU - Scheel, Michael

AU - Martola, Juha

AU - Wheeler, Matthew

AU - Owen, Stephanie

AU - Johnsson, Mikael

AU - Annborn, Martin

AU - Dankiewicz, Josef

AU - Deye, Nicolas

AU - Düring, Joachim

AU - Friberg, Hans

AU - Halliday, Thomas

AU - Jakobsen, Janus Christian

AU - Lascarrou, Jean-Baptiste

AU - Levin, Helena

AU - Lilja, Gisela

AU - Lybeck, Anna

AU - McGuigan, Peter

AU - Rylander, Christian

AU - Sem, Victoria

AU - Thomas, Matthew

AU - Ullén, Susann

AU - Undén, Johan

AU - Wise, Matt P

AU - Cronberg, Tobias

AU - Wassélius, Johan

AU - Nielsen, Niklas

AU - Leithner, Christoph

AU - Moseby-Knappe, Marion

PY - 2024/7

Y1 - 2024/7

N2 - PURPOSE: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest.METHODS: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey-white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4-6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated.RESULTS: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59-76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90-100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77-0.91) did not significantly differ from manually obtained GWR.CONCLUSION: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.

AB - PURPOSE: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest.METHODS: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey-white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4-6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated.RESULTS: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59-76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90-100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77-0.91) did not significantly differ from manually obtained GWR.CONCLUSION: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.

KW - Aged

KW - Female

KW - Head/diagnostic imaging

KW - Humans

KW - Hypothermia, Induced/methods

KW - Male

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest/therapy

KW - Predictive Value of Tests

KW - Prognosis

KW - Prospective Studies

KW - Tomography, X-Ray Computed/methods

KW - GWR

KW - Hypoxic–ischaemic encephalopathy

KW - Cardiac arrest

KW - Computed tomography

UR - https://www.scopus.com/pages/publications/85196384410

U2 - 10.1007/s00134-024-07497-2

DO - 10.1007/s00134-024-07497-2

M3 - Journal article

C2 - 38900283

SN - 0342-4642

VL - 50

SP - 1096

EP - 1107

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 7

ER -

Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study

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