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The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest
  1. S P Choi1,
  2. H K Park2,
  3. K N Park1,
  4. Y M Kim1,
  5. K J Ahn3,
  6. K H Choi1,
  7. W J Lee1,
  8. S K Jeong1
  1. 1
    Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
  2. 2
    Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
  3. 3
    Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
  1. Dr K N Park, Department of Emergency Medicine, St Mary’s Hospital, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul, Korea 150-713; emsky{at}catholic.ac.kr

Abstract

Objectives: To evaluate whether the ratio (in Hounsfield units; HU) of grey matter (GM) to white matter (WM) on computed tomography (CT) scans taken within 24 h of resuscitation can be used as a predictor of outcome.

Methods: 28 patients who resuscitated from cardiac arrest and had head CT performed within 24 h of resuscitation were retrospectively investigated. 27 subjects with normal head CT findings served as controls. Comatose patients were divided into two groups: those with a Glasgow outcome scale (GOS) score of 3–5 (good outcome subgroup) and those with a GOS score of 1–2 (poor outcome subgroup). HU were measured in GM and WM at the level of the basal ganglia on non-contrast CT scans.

Results: The density ratio of GM to WM was significantly lower in comatose patients than in controls (mean 1.21 vs 1.32, p<0.001). The GM:WM ratio was significantly lower in the poor subgroup than in the good subgroup (mean 1.19 vs 1.28, p<0.001). Receiver operating characteristic curve analysis determined a cutoff value of a GM:WM ratio of less than 1.22 for vegetative state or death. This value predicted vegetative state or death with a sensitivity of 63%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 56%.

Conclusion: The GM/WM ratio correlates with the outcome of hypoxic ischaemic encephalopathy and may be useful as an objective early predictor of vegetative state or death in comatose patients after cardiac arrest.

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Footnotes

  • Competing interests: None.

  • Ethics approval: The study was approved by the local ethics committee of the university hospital.

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