Maayke Hunfeld

155 MRI and prognosis Association between brain MRI findings and neurological outcome A description of brain MRI abnormalities of all patients is presented in Supplemental Table 3. The impact of the brain MRI is summarized in Table 3 in terms of sensitivity, specificity, PPV and NPV. Death and poor neurological outcome at hospital discharge Brain MRI was abnormal in all of the 13 deceased children: 3 had focal brain injury and 10 had extensive injury. In children with poor outcome (n=9), brain MRI was normal in 2. In 4 children brain MRI showed focal brain injury and in 3 extensive injury. Brain MRI findings are specified by cause of death in Supplemental Table 4. The presence of extensive brain injury on imaging was strongly associated with a poor outcome and death, with a PPV of 100% (specificity 100%) (Table 3). Focal brain injury had a PPV of 55% (PPV with or without involvement of deep grey matter was resp. 50% and 67%), reflecting poor neurological outcome or death in 55% of children with focal injury. Bilateral injury in brain lobes, watershed regions, perirolandic region, corticospinal tract, hippocampus, corpus callosum, cerebellum, dentate nuclei, brainstem or deep grey matter were each associated with poor outcome or death (Supplemental Table 5). Brain MRI abnormalities of 2 patients (both died) are illustrated in Figure 2. Death and poor neurological outcome two years post-OHCA In both children with poor neurological outcome brain MRI showed focal brain injury. One child with severe neurological sequelae post-OHCA died 6 months later due to a pneumonia. Brain MRI <1 week after OHCA showed extensive brain injury. The presence of extensive brain injury on MRI was strongly associated with poor outcome (both including and excluding death), with a PPV of 100% (specificity 100%) (Table 3). Focal injury on brain MRI had a PPV of 44%, reflecting poor neurological outcome or death 2 years post-OHCA in 44% of children with focal brain injury. Bilateral injury in brain lobes, watershed regions, perirolandic region, hippocampus, corpus callosum, cerebellum, brain stem, or deep grey matter were associated with poor outcome or death (Supplemental Table 5). Good neurological outcome at hospital discharge Brain MRI was normal in 13/18 children with good outcome. Focal injury was found in 5 children. 5