{
  "abstract": "IntroductionPost-cardiac arrest brain injury (PCABI) patterns across patients are heterogeneous, and conventional clinical variables incompletely capture in vivo injury severity. Here, we evaluated whether anatomically resolved diffusion-weighted MRI (DWI) lesion patterns identify biologically distinct PCABI phenotypes.\n\nMethodsWe conducted a retrospective study of patients with PCABI who underwent brain MRI and intraparenchymal brain tissue oxygen tension (PbtO2) monitoring (n = 24). Ischemic lesion burden was quantified using an MNI atlas-based apparent diffusion coefficient pipeline with a voxel intensity threshold of <650x10-6 mm{superscript 2}/s and was summarized at whole-brain, hemispheric, tissue-class, and segment-levels. Principal component analysis (PCA) and k-means clustering were used to identify MRI- derived injury patterns for downstream physiological analysis.\n\nResultsGreater whole-brain lesion burden was associated with lower mean PbtO2 (r = -0.49, p = 0.014), with concurrent associations in the left hemisphere (r = -0.50, p = 0.012), right hemisphere (r = -0.48, p = 0.019), grey matter (r = -0.48, p = 0.018), and white matter (r = -0.49, p = 0.016). PCA identified a dominant lesion-pattern axis associated with PbtO2 (r = 0.48, p = 0.0169). K-means clustering in PC1- PC2 space identified three MRI-derived injury patterns with distinct regional signatures and progressively greater whole-brain lesion burden (p < 0.001).\n\nDiscussionGreater MRI-defined lesion burden was associated with lower PbtO2 post-cardiac arrest. Anatomically resolved DWI/ADC lesion mapping identified three MRI-derived injury patterns that differed in cerebrovascular physiology, lesion patterning and whole-brain injury burden. Integrating quantitative MRI, intraparenchymal neuromonitoring, and blood biomarkers improved the characterization of the heterogeneity observed in PCABI patients.\n\nHIGHLIGHTSO_LIAtlas DWI/ADC mapping identified three MRI-derived injury patterns. C_LIO_LIMRI-derived patterns captured regional injury beyond whole-brain burden. C_LIO_LIGreater ischemic lesion burden was associated with lower PbtO2. C_LIO_LIMRI-derived patterns differed in PbtO2 and selected biomarkers. C_LIO_LIBrain injury patterns were not explained by admission physiology nor time to ROSC. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "University of British Columbia"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "name": "C. A. Larkey"
    },
    {
      "name": "G. Ambwani"
    },
    {
      "name": "W. Limaye"
    },
    {
      "name": "S. Stukas"
    },
    {
      "name": "J. Cooper"
    },
    {
      "name": "C. L. Wellington"
    },
    {
      "name": "P. A. Gooderham"
    },
    {
      "name": "D. Foster"
    },
    {
      "name": "D. E. Griesdale"
    },
    {
      "name": "M. S. Sekhon"
    },
    {
      "name": "W. Guest"
    },
    {
      "affs": [
        0
      ],
      "name": "R. L. Hoiland"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dcqw99ww3n070.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.03.26362123",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362123v1.full",
  "id": "dcqw99ww3n070",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362123v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "intensive care and critical care medicine"
    ],
    [
      "openalex",
      "2711|Cardiac Arrest and Resuscitation"
    ]
  ],
  "openalex": "W7211923723",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362123v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dcqw99ww3n070.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:57Z",
      "native_id": "10.64898/2026.09.03.26362123",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362123v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:intensive care and critical care medicine",
      "subfield": "general"
    }
  ],
  "title": "MRI-Derived Patterns of Post-Cardiac Arrest Brain Injury: Linking Anatomical Injury and Cerebrovascular Physiology",
  "title_text": "MRI-Derived Patterns of Post-Cardiac Arrest Brain Injury: Linking Anatomical Injury and Cerebrovascular Physiology",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:57Z",
  "url": "https://research.draconitic.com/paper/dcqw99ww3n070",
  "venue": "medRxiv",
  "versions": []
}