Maayke Hunfeld

161 MRI and prognosis brain MRIs must be performed using to the same acquisition parameters, scan quality (preferably on the same scanner), and timing. Another possible prognostic tool for pediatric comatose OHCA survivors might be the use of quantitative brain MRI, such as brain diffusion tensor imaging (DTI). With DTI it is possible to calculate the fractional anisotropy, which indicates the quantification of white matter injuries that occur during and around global anoxia (25, 26). In a prospective multicenter cohort of adult patients who were comatose 7 days after CA, whole brain white matter fractional anisotropy based on DTI could accurately predict neurological outcome at 6 months post-CA (27). DTI also includes white matter tractography, which studies the organization of structural connectivity (28). In children with moderate and severe traumatic brain injury, tractography has revealed abnormal re-organization of the structural connectome (comprehensive map of neural connections in the brain) which was associated with impaired neurocognitive function (29). Conclusion A normal brain MRI within 1 week after OHCA is predictive for good neurological outcome 2 years post-OHCA. Conversely, the presence of extensive brain injury on MRI within 1 week post-OHCA predicts poor neurological outcome or death at discharge and 2 years post-OHCA. Based on MRI with focal brain injury, it is impossible to predict neurological outcome accurately. Further research in larger cohorts is needed, by international collaboration, to improve the prognostic accuracy of brain MRI. Outcome should not only focus on survival and PCPC, it should also include neurocognitive function, physical functioning and basic daily life skills. 5