ArticleBMC neurology2021
Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest.
Article in BMC neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care.Intensive care medicine · 2025Guideline
- Guidelines for Neuroprognostication in Comatose Adult Survivors of Cardiac Arrest.Neurocritical care · 2023Guideline
- Does timing matter? Unlocking the value of repeated MRI in the early phases after severe traumatic brain injury.Acta neurochirurgica · 2026Article
- Gray-white matter ratio in pediatric and adult cardiopulmonary arrest studies: a rapid review.Resuscitation plus · 2026Review
- Multimodal contrastive prognostication framework for early neurological outcome prediction in post-cardiac arrest patients.Scientific reports · 2026Article
- Correlation of Gray-to-White matter ratio on Non-Contrast CT with neurological outcome in Post-Cardiac arrest syndrome.BMJ neurology open · 2026Article
- Longitudinal assessment of automated gray-white matter ratio for outcome prediction after cardiac arrest.Critical care (London, England) · 2025Article
- Optimizing brain protection after cardiac arrest: advanced strategies and best practices.Interface focus · 2024Review
- Application of multi-feature-based machine learning models to predict neurological outcomes of cardiac arrest.Resuscitation plus · 2024Review
- Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study.Intensive care medicine · 2024Observational
- Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2023Review
- Use of Prognostication Instruments in Prognostication Procedures of Postanoxic Coma Patients over Time: A Retrospective Study.Journal of clinical medicine · 2023Article
- Prognostic accuracy of head computed tomography for prediction of functional outcome after out-of-hospital cardiac arrest: Rationale and design of the prospective TTM2-CT-substudy.Resuscitation plus · 2022Article
- Inter-rater agreement between humans and computer in quantitative assessment of computed tomography after cardiac arrest.Frontiers in neurology · 2022Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest.
methodsWe retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event.
resultsGray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592-0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320-0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed.
conclusionsA reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.
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