J Korean Soc Emerg Med.  2024 Apr;35(2):95-100.

Quantitative size measurement of the posterior ambient cistern in early brain computed tomography of patients with cardiac arrest

• Lee C
• Lee JH

Abstract

Objective
Predictors for neuroprognostication in early brain computed tomography (CT) within 24 hours of cardiac arrest are available for patients, but have not been very promising. Quantitative cistern effacement has not been investigated, although the gray matter to white matter ratio (GWR) and optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) in early brain CT have been extensively studied. We aimed to determine the performance of quantitative cistern effacement compared to that of GWRs and ONSD/ETD for neuroprognostication.
Methods
This retrospective study was performed in a tertiary teaching hospital and included adult patients with cardiac arrest who underwent brain CT and targeted temperature management. GWRs, the distance of the posterior ambient cistern, and ONSD/ETD in early brain CT were measured.
Results
Among the 75 patients included in the study, 36 patients showed poor neurological outcomes. The region of interest (ROI) in the putamen was significantly different in patients with a poor neurological outcome (P=0.031), but the ROI in the caudate nucleus was not (P=0.229). ONSD/ETD was not correlated with a poor neurological outcome. When compared with the GWR of the putamen/posterior internal capsule (odds ratio [OR], 0.619; P=0.063) and ONSD/ETD (OR, 1.774; P=0.457), the distance of the posterior ambient cistern correlated most with poor neurological outcomes (OR, 0.494; P=0.013,) and the area under receiver operating characteristic curve was 0.689.
Conclusion
Quantitative cistern effacement in the early brain CT of cardiac arrest patients can assist neuroprognostication. Studies with larger sample sizes and follow-up of brain CT are warranted to confirm these results.

Keyword

Out-of-hospital cardiac arrest; Multidetector computed tomography; Prognosis