Quantitative assessment of blood-brain barrier permeability using biotechnological imaging analysis in contrast-enhanced magnetic resonance imaging during post-resuscitation care: Stratified associations by illness severity.

Abstract

This study aimed to explore the usefulness of quantitative measurement of gadolinium leakage into the brain parenchyma in contrast-enhanced magnetic resonance image (CE-MRI) as a surrogate marker of blood-brain barrier (BBB) permeability. This retrospective study included the patients who underwent post-resuscitation care after out-of-hospital cardiac arrest and received CE-MRI, with BBB permeability assessed by the cerebrospinal fluid (CSF)/serum albumin quotient (Qa). The delta value of contrast between pre- and post-contrast images in CE-MRI (ΔCon) was quantitatively calculated using biotechnological analysis and compared with Qa. The primary outcome involved assessing the relationship between these two measures. Subgroup analyses were performed according to illness severity based on the Pittsburgh Cardiac Arrest Category (PCAC) groups (mild [PCAC 2], moderate [PCAC 3], and severe [PCAC 4]). In the total cohort, the mean difference (ΔCon - Qa) was 0.34, indicating that ΔCon yielded consistently higher values than Qa. The 95 % limits of agreement ranged from 0.11 to 0.57, demonstrating substantial variability between the two measurements. In subgroup analysis according to PCAC, PCAC 2 and PCAC 4 demonstrated non-significant associations. However, the PCAC 3 showed a significant predictive performance of ΔCon for Qa (β = 2.94, p = 0.03, pseudo-R² = 0.35), indicating a modest improvement over linear regression. This study demonstrated no significant relationship between non-invasive ΔCon derived from CE-MRI and invasive Qa when illness severity remained unstratified. After stratifying by illness severity, a subtle association between ΔCon and Qa emerged, specifically in patients with moderate severity of cardiac arrest.