Brain edema progression rate on serial CT predicts neurological outcome after cardiac arrest: a region-specific biomarker of hypoxic-ischemic brain injury.
- 1Emergency Department, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
- 2Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
Abstract
Objectives
To evaluate the prognostic performance of the attenuation change rate on serial brain computed tomography (CT), a novel quantitative marker of temporal cerebral attenuation change, for predicting poor neurological outcome after cardiac arrest (CA).Methods
This was a retrospective analysis of a prospective cohort. CA patients who underwent cranial CT both within 12 h and between 12 h and one week after return of spontaneous circulation (ROSC) were included. The attenuation change rate, calculated as the HU difference between paired scans divided by the time interval, was measured in 12 predefined brain regions. Neurological outcome was assessed using the Cerebral Performance Category (CPC) at discharge.Results
Of 53 patients enrolled, 17 (32.1%) had favorable neurological outcomes at discharge. Patients with poor outcomes exhibited significantly greater attenuation decline rates in all gray matter regions except for gray matter at the centrum semiovale level, including the caudate nucleus (-0.01 vs. 0.02 HU/h), putamen (-0.02 vs. 0 HU/h), thalamus (-0.02 vs. 0.01 HU/h), gray matter of the high convexity (-0.02 vs. 0 HU/h), and cerebellar gray matter (-0.02 vs. 0.03 HU/h) (all P < 0.01), whereas no statistically significant differences were observed in any of the white matter regions. ROC analysis demonstrated AUCs ranging from 0.725 to 0.778, with cerebellar gray matter achieving the highest AUC (0.778; sensitivity, 75.0%; specificity, 76.5%). At the 100% specificity threshold, the caudate nucleus showed the highest sensitivity for predicting poor outcome (36.1% at a decline rate of -0.040 HU/h).Conclusion
Serial CT-derived attenuation change rate may serve as an exploratory quantitative marker of cerebral edema progression after cardiac arrest. However, this single-center, small-sample study does not support its use for withdrawal of life-sustaining treatment decisions. Multicenter validation is warranted.
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BibTeX
@article{xu2026brain,
title = {{Brain edema progression rate on serial CT predicts neurological outcome after cardiac arrest: a region-specific biomarker of hypoxic-ischemic brain injury.}},
author = {Nengyuan Xu and Hoikei Cheong and Zhen De and Xintong Li and Yan Wang and Xiangzhu Zeng and Lanfang Du},
journal = {Resuscitation plus},
year = {2026},
month = sep,
doi = {10.1016/j.resplu.2026.101509},
url = {https://europepmc.org/article/MED/42904189},
note = {CC BY},
}
RIS
TY - JOUR
TI - Brain edema progression rate on serial CT predicts neurological outcome after cardiac arrest: a region-specific biomarker of hypoxic-ischemic brain injury.
AU - Nengyuan Xu
AU - Hoikei Cheong
AU - Zhen De
AU - Xintong Li
AU - Yan Wang
AU - Xiangzhu Zeng
AU - Lanfang Du
PY - 2026
DA - 2026/09/29
JO - Resuscitation plus
DO - 10.1016/j.resplu.2026.101509
UR - https://europepmc.org/article/MED/42904189
AB - Objectives To evaluate the prognostic performance of the attenuation change rate on serial brain computed tomography (CT), a novel quantitative marker of temporal cerebral attenuation change, for predicting poor neurological outcome after cardiac arrest (CA).Methods This was a retrospective analysis of a prospective cohort. CA patients who underwent cranial CT both within 12 h and between 12 h and one week after return of spontaneous circulation (ROSC) were included. The attenuation change rate, calculated as the HU difference between paired scans divided by the time interval, was measured in 12 predefined brain regions. Neurological outcome was assessed using the Cerebral Performance Category (CPC) at discharge.Results Of 53 patients enrolled, 17 (32.1%) had favorable neurological outcomes at discharge. Patients with poor outcomes exhibited significantly greater attenuation decline rates in all gray matter regions except for gray matter at the centrum semiovale level, including the caudate nucleus (-0.01 vs. 0.02 HU/h), putamen (-0.02 vs. 0 HU/h), thalamus (-0.02 vs. 0.01 HU/h), gray matter of the high convexity (-0.02 vs. 0 HU/h), and cerebellar gray matter (-0.02 vs. 0.03 HU/h) (all P < 0.01), whereas no statistically significant differences were observed in any of the white matter regions. ROC analysis demonstrated AUCs ranging from 0.725 to 0.778, with cerebellar gray matter achieving the highest AUC (0.778; sensitivity, 75.0%; specificity, 76.5%). At the 100% specificity threshold, the caudate nucleus showed the highest sensitivity for predicting poor outcome (36.1% at a decline rate of -0.040 HU/h).Conclusion Serial CT-derived attenuation change rate may serve as an exploratory quantitative marker of cerebral edema progression after cardiac arrest. However, this single-center, small-sample study does not support its use for withdrawal of life-sustaining treatment decisions. Multicenter validation is warranted.
SN - 2666-5204
ER -