MRI-Derived Patterns of Post-Cardiac Arrest Brain Injury: Linking Anatomical Injury and Cerebrovascular Physiology
- 1University of British Columbia
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.
MethodsWe 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.
ResultsGreater 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).
DiscussionGreater 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.
HIGHLIGHTSO_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
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BibTeX
@misc{larkey2026mriderived,
title = {{MRI-Derived Patterns of Post-Cardiac Arrest Brain Injury: Linking Anatomical Injury and Cerebrovascular Physiology}},
author = {C. A. Larkey and G. Ambwani and W. Limaye and S. Stukas and J. Cooper and C. L. Wellington and P. A. Gooderham and D. Foster and D. E. Griesdale and M. S. Sekhon and W. Guest and R. L. Hoiland},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.03.26362123},
url = {https://www.medrxiv.org/content/10.64898/2026.09.03.26362123v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - MRI-Derived Patterns of Post-Cardiac Arrest Brain Injury: Linking Anatomical Injury and Cerebrovascular Physiology
AU - C. A. Larkey
AU - G. Ambwani
AU - W. Limaye
AU - S. Stukas
AU - J. Cooper
AU - C. L. Wellington
AU - P. A. Gooderham
AU - D. Foster
AU - D. E. Griesdale
AU - M. S. Sekhon
AU - W. Guest
AU - R. L. Hoiland
PY - 2026
DA - 2026/09/03
PB - medRxiv
DO - 10.64898/2026.09.03.26362123
UR - https://www.medrxiv.org/content/10.64898/2026.09.03.26362123v1
AB - 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. MethodsWe 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. ResultsGreater 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). DiscussionGreater 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. HIGHLIGHTSO_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
ER -