Investig Magn Reson Imaging.  2018 Mar;22(1):56-60. 10.13104/imri.2018.22.1.56.

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

• Kim MJ
• Park YW
• Lim SM

• KMID: 2408818
• DOI: http://doi.org/10.13104/imri.2018.22.1.56

Abstract

Therapeutic hypothermia in cardiac arrest patients is associated with favorable outcomes mediated via neuroprotective mechanisms. We report a rare case of a 32-year-old male who demonstrated complete recovery of signal changes on perfusion-weighted imaging after therapeutic hypothermia due to cardiac arrest. Brain MRI with perfusion-weighted imaging, performed three days after ending the hypothermia therapy, showed a marked decrease in relative cerebral blood flow (rCBF) and delay in mean transit time (MTT) in the bilateral basal ganglia, thalami, brain stem, cerebellum, occipitoparietal cortex, and frontotemporal cortex. However, no cerebral ischemia was not noted on diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR) sequences. A follow-up brain MRI after one week showed complete resolution of the perfusion deficit and the patient was discharged without any neurologic sequelae. The mechanism and interpretation of the perfusion changes in cardiac arrest patients treated with therapeutic hypothermia are discussed.

Keyword

Perfusion; Hypothermia; Cardiac arrest; Recovery; Brain

MeSH Terms

Adult
Basal Ganglia
Brain
Brain Ischemia
Brain Stem
Cerebellum
Cerebrovascular Circulation
Follow-Up Studies
Heart Arrest*
Humans
Hypothermia*
Hypothermia, Induced
Magnetic Resonance Imaging*
Male
Perfusion*

Figure

• 

  Fig. 1 Initial brain perfusion-weighted imaging (a-d) showed delay in mean transit time (MTT) with decreased relative cerebral blood flow (rCBF) in bilateral basal ganglia, thalami, occipital cortex and temporal cortex (arrows in a, c), which were recovered on follow-up imaging (e-h). rCBV = relative cerebral blood volume; TTP = time to peak

• 

  Fig. 2 Diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) map, and fluid-attenuated inversion recovery (FLAIR) imaging showed no evidence of ischemic changes in initial (a-c) and follow-up (d-f) imaging.

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