Prognostic Implication of Ventricular Volumetry in Early Brain Computed Tomography after Cardiac Arrest
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. Brain CT Acquisitions and Postresuscitation Care
2.3. Brain CT Interpretation
2.4. Outcome Measurement
2.5. Statistical Analysis
3. Results
3.1. Characteristics of the Study Participants
3.2. Comparison of Brain CT between the Outcome Groups
3.3. Prognostic Performance of the GWR Alone and Ventricular Volume Alone
3.4. Multivariable Logistic Regression Models for Predicting Poor Outcomes
3.5. Relationships between Lateral and Fourth Ventricular Volumes and Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Perkins, G.D.; Callaway, C.W.; Haywood, K.; Neumar, R.W.; Lilja, G.; Rowland, M.J.; Sawyer, K.N.; Skrifvars, M.B.; Nolan, J.P. Brain injury after cardiac arrest. Lancet 2021, 398, 1269–1278. [Google Scholar] [CrossRef] [PubMed]
- Nolan, J.P.; Sandroni, C.; Bottiger, B.W.; Cariou, A.; Cronberg, T.; Friberg, H.; Genbrugge, C.; Haywood, K.; Lilja, G.; Moulaert, V.R.M.; et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021, 161, 220–269. [Google Scholar] [CrossRef]
- Panchal, A.R.; Bartos, J.A.; Cabanas, J.G.; Donnino, M.W.; Drennan, I.R.; Hirsch, K.G.; Kudenchuk, P.J.; Kurz, M.C.; Lavonas, E.J.; Morley, P.T.; et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020, 142, S366–S468. [Google Scholar] [CrossRef] [PubMed]
- Chang, J.J.; Tsivgoulis, G.; Goyal, N.; Alsherbini, K.; Schuring, C.; Shrestha, R.; Yankovich, A.; Metter, J.E.; Sareen, S.; Elijovich, L.; et al. Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest. J. Neurol. Sci. 2019, 406, 116437. [Google Scholar] [CrossRef] [PubMed]
- Hwan Kim, Y.; Ho Lee, J.; Kun Hong, C.; Won Cho, K.; Hoon Yeo, J.; Ju Kang, M.; Weon Kim, Y.; Yul Lee, K.; Joo Kim, J.; Youn Hwang, S. Feasibility of optic nerve sheath diameter measured on initial brain computed tomography as an early neurologic outcome predictor after cardiac arrest. Acad. Emerg. Med. 2014, 21, 1121–1128. [Google Scholar] [CrossRef] [PubMed]
- Friberg, H.; Cronberg, T.; Dünser, M.W.; Duranteau, J.; Horn, J.; Oddo, M. Survey on current practices for neurological prognostication after cardiac arrest. Resuscitation 2015, 90, 158–162. [Google Scholar] [CrossRef] [PubMed]
- Inamasu, J.; Miyatake, S.; Suzuki, M.; Nakatsukasa, M.; Tomioka, H.; Honda, M.; Kase, K.; Kobayashi, K. Early CT signs in out-of-hospital cardiac arrest survivors: Temporal profile and prognostic significance. Resuscitation 2010, 81, 534–538. [Google Scholar] [CrossRef]
- Langkjaer, S.; Hassager, C.; Kjaergaard, J.; Salam, I.; Thomsen, J.H.; Lippert, F.K.; Wanscher, M.; Kober, L.; Nielsen, N.; Soholm, H. Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients. Resuscitation 2015, 92, 141–147. [Google Scholar] [CrossRef]
- Kim, S.H.; Choi, S.P.; Park, K.N.; Youn, C.S.; Oh, S.H.; Choi, S.M. Early brain computed tomography findings are associated with outcome in patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest. Scand. J. Trauma. Resusc. Emerg. Med. 2013, 21, 57. [Google Scholar] [CrossRef]
- Lee, B.K.; Jeung, K.W.; Song, K.H.; Jung, Y.H.; Choi, W.J.; Kim, S.H.; Youn, C.S.; Cho, I.S.; Lee, D.H.; Korean Hypothermia Network, I. Prognostic values of gray matter to white matter ratios on early brain computed tomography in adult comatose patients after out-of-hospital cardiac arrest of cardiac etiology. Resuscitation 2015, 96, 46–52. [Google Scholar] [CrossRef]
- Na, M.K.; Kim, W.; Lim, T.H.; Jang, B.; Cho, Y.; Choi, K.S.; Shin, H.G.; Ahn, C.; Lee, J.; Kim, J.G. Gray matter to white matter ratio for predicting neurological outcomes in patients treated with target temperature management after cardiac arrest: A systematic review and meta-analysis. Resuscitation 2018, 132, 21–28. [Google Scholar] [CrossRef] [PubMed]
- Hong, J.Y.; Lee, D.H.; Oh, J.H.; Lee, S.H.; Choi, Y.H.; Kim, S.H.; Min, J.H.; Kim, S.J.; Park, Y.S. Grey-white matter ratio measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest. Resuscitation 2019, 140, 161–169. [Google Scholar] [CrossRef]
- Scarpino, M.; Lolli, F.; Lanzo, G.; Carrai, R.; Spalletti, M.; Valzania, F.; Lombardi, M.; Audenino, D.; Celani, M.G.; Marrelli, A.; et al. Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: The ProNeCA prospective multicentre prognostication study. Resuscitation 2019, 143, 115–123. [Google Scholar] [CrossRef] [PubMed]
- Lopez Soto, C.; Dragoi, L.; Heyn, C.C.; Kramer, A.; Pinto, R.; Adhikari, N.K.J.; Scales, D.C. Imaging for Neuroprognostication After Cardiac Arrest: Systematic Review and Meta-analysis. Neurocrit Care 2020, 32, 206–216. [Google Scholar] [CrossRef] [PubMed]
- Wilson, M.H. Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure. J. Cereb. Blood Flow. Metab. 2016, 36, 1338–1350. [Google Scholar] [CrossRef]
- Hayman, E.G.; Patel, A.P.; Kimberly, W.T.; Sheth, K.N.; Simard, J.M. Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest? Neurocrit Care 2018, 28, 276–287. [Google Scholar] [CrossRef] [PubMed]
- You, Y.H.; Park, J.S.; Yoo, I.S.; Min, J.H.; Jeong, W.J.; Cho, Y.C.; Ryu, S.; Lee, J.W.; Kim, S.W.; Cho, S.U.; et al. Usefulness of a quantitative analysis of the cerebrospinal fluid volume proportion in brain computed tomography for predicting neurological prognosis in cardiac arrest survivors who undergo target temperature management. J. Crit. Care 2019, 51, 170–174. [Google Scholar] [CrossRef] [PubMed]
- Lee, D.H.; Lee, B.K.; Jeung, K.W.; Jung, Y.H.; Cho, Y.S.; Cho, I.S.; Youn, C.S.; Kim, J.W.; Park, J.S.; Min, Y.I. Relationship between ventricular characteristics on brain computed tomography and 6-month neurologic outcome in cardiac arrest survivors who underwent targeted temperature management. Resuscitation 2018, 129, 37–42. [Google Scholar] [CrossRef]
- Lee, B.K.; Callaway, C.W.; Coppler, P.J.; Rittenberger, J.C.; Pittsburgh Post-Cardiac Arrest, S. The prognostic performance of brain ventricular characteristic differ according to sex, age, and time after cardiac arrest in comatose out-of-hospital cardiac arrest survivors. Resuscitation 2020, 154, 69–76. [Google Scholar] [CrossRef]
- Choi, S.Y.; Oh, S.H.; Park, K.N.; Youn, C.S.; Kim, H.J.; Park, S.H.; Lim, J.Y.; Kim, H.J.; Bang, H.J. Association between early lactate-related variables and 6-month neurological outcome in out-of-hospital cardiac arrest patients. Am. J. Emerg. Med. 2024, 78, 62–68. [Google Scholar] [CrossRef]
- Kim, Y.M.; Park, K.N.; Choi, S.P.; Lee, B.K.; Park, K.; Kim, J.; Kim, J.H.; Chung, S.P.; Hwang, S.O. Part 4. Post-cardiac arrest care: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin. Exp. Emerg. Med. 2016, 3, S27–S38. [Google Scholar] [CrossRef] [PubMed]
- Yushkevich, P.A.; Piven, J.; Hazlett, H.C.; Smith, R.G.; Ho, S.; Gee, J.C.; Gerig, G. User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliability. Neuroimage 2006, 31, 1116–1128. [Google Scholar] [CrossRef] [PubMed]
- DeLong, E.R.; DeLong, D.M.; Clarke-Pearson, D.L. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics 1988, 44, 837–845. [Google Scholar] [CrossRef] [PubMed]
- Peduzzi, P.; Concato, J.; Kemper, E.; Holford, T.R.; Feinstein, A.R. A simulation study of the number of events per variable in logistic regression analysis. J. Clin. Epidemiol. 1996, 49, 1373–1379. [Google Scholar] [CrossRef] [PubMed]
- Ho, M.L.; Rojas, R.; Eisenberg, R.L. Cerebral edema. AJR Am. J. Roentgenol. 2012, 199, W258–W273. [Google Scholar] [CrossRef] [PubMed]
- Streitberger, K.J.; Endisch, C.; Ploner, C.J.; Stevens, R.; Scheel, M.; Kenda, M.; Storm, C.; Leithner, C. Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest. Resuscitation 2019, 145, 8–14. [Google Scholar] [CrossRef] [PubMed]
- Wang, G.N.; Chen, X.F.; Lv, J.R.; Sun, N.N.; Xu, X.Q.; Zhang, J.S. The prognostic value of gray-white matter ratio on brain computed tomography in adult comatose cardiac arrest survivors. J. Chin. Med. Assoc. 2018, 81, 599–604. [Google Scholar] [CrossRef]
- Moseby-Knappe, M.; Pellis, T.; Dragancea, I.; Friberg, H.; Nielsen, N.; Horn, J.; Kuiper, M.; Roncarati, A.; Siemund, R.; Unden, J.; et al. Head computed tomography for prognostication of poor outcome in comatose patients after cardiac arrest and targeted temperature management. Resuscitation 2017, 119, 89–94. [Google Scholar] [CrossRef] [PubMed]
- Chae, M.K.; Ko, E.; Lee, J.H.; Lee, T.R.; Yoon, H.; Hwang, S.Y.; Cha, W.C.; Shin, T.G.; Sim, M.S.; Jo, I.J.; et al. Better prognostic value with combined optic nerve sheath diameter and grey-to-white matter ratio on initial brain computed tomography in post-cardiac arrest patients. Resuscitation 2016, 104, 40–45. [Google Scholar] [CrossRef]
- Beekman, R.; Hirsch, K.G. Brain imaging after cardiac arrest. Curr. Opin. Crit. Care 2023, 29, 192–198. [Google Scholar] [CrossRef]
- Song, H.; Kang, C.; Park, J.; You, Y.; In, Y.; Min, J.; Jeong, W.; Cho, Y.; Ahn, H.; Kim, D. Intracranial Pressure Patterns and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Survivors after Targeted Temperature Management: A Retrospective Observational Study. J. Clin. Med. 2021, 10, 5697. [Google Scholar] [CrossRef] [PubMed]
- Mortazavi, M.M.; Adeeb, N.; Griessenauer, C.J.; Sheikh, H.; Shahidi, S.; Tubbs, R.I.; Tubbs, R.S. The ventricular system of the brain: A comprehensive review of its history, anatomy, histology, embryology, and surgical considerations. Childs Nerv. Syst. 2014, 30, 19–35. [Google Scholar] [CrossRef]
- Stratchko, L.; Filatova, I.; Agarwal, A.; Kanekar, S. The Ventricular System of the Brain: Anatomy and Normal Variations. Semin. Ultrasound CT MR 2016, 37, 72–83. [Google Scholar] [CrossRef]
- Kim, J.; Lee, J.H. Quantitative cistern effacement and reduced gray to white matter ratio for prognostication in early brain computed tomography of patients with cardiac arrest. Heliyon 2024, 10, e23741. [Google Scholar] [CrossRef] [PubMed]
- In, Y.N.; Kim, H.I.; Park, J.S.; Kang, C.; You, Y.; Min, J.H.; Lee, D.; Lee, I.H.; Jeong, H.S.; Lee, B.K.; et al. Association between quantitative analysis of cerebral edema using CT imaging and neurological outcomes in cardiac arrest survivors. Am. J. Emerg. Med. 2024, 78, 22–28. [Google Scholar] [CrossRef] [PubMed]
- Yang, D.; Ha, S.G.; Ryoo, E.; Choi, J.Y.; Kim, H.J. Multimodal assessment using early brain CT and blood pH improve prediction of neurologic outcomes after pediatric cardiac arrest. Resuscitation 2019, 137, 7–13. [Google Scholar] [CrossRef] [PubMed]
- Trimarchi, F.; Bramanti, P.; Marino, S.; Milardi, D.; Di Mauro, D.; Ielitro, G.; Valenti, B.; Vaccarino, G.; Milazzo, C.; Cutroneo, G. MRI 3D lateral cerebral ventricles in living humans: Morphological and morphometrical age-, gender-related preliminary study. Anat. Sci. Int. 2013, 88, 61–69. [Google Scholar] [CrossRef]
- Kellogg, R.T.; Park, M.S.; Snyder, M.H.; Marino, A.; Patel, S.; Feng, X.; Vargas, J. Establishment of Age- and Sex-Specific Reference Cerebral Ventricle Volumes. World Neurosurg. 2023, 175, e976–e983. [Google Scholar] [CrossRef] [PubMed]
- Oh, S.H.; Park, K.N.; Lim, J.; Choi, S.P.; Oh, J.S.; Cho, I.S.; Lee, B.K.; Kim, Y.H.; Kim, Y.M.; Kim, H.J.; et al. The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management. Crit. Care 2017, 21, 272. [Google Scholar] [CrossRef]
- Akdogan, I.; Kiroglu, Y.; Onur, S.; Karabuluti, N. The volume fraction of brain ventricles to total brain volume: A computed tomography stereological study. Folia Morphol. 2010, 69, 193–200. [Google Scholar]
- Fujita, S.; Mori, S.; Onda, K.; Hanaoka, S.; Nomura, Y.; Nakao, T.; Yoshikawa, T.; Takao, H.; Hayashi, N.; Abe, O. Characterization of Brain Volume Changes in Aging Individuals With Normal Cognition Using Serial Magnetic Resonance Imaging. JAMA Netw. Open 2023, 6, e2318153. [Google Scholar] [CrossRef] [PubMed]
Good Outcome (n = 51) | Poor Outcome (n = 115) | p-Value | |
---|---|---|---|
Male | 38 (74.5) | 75 (65.2) | 0.236 |
Age, years, mean ± SD | 51.7 ± 14.4 | 58.6 ± 16.3 | 0.010 |
Coronary artery disease | 14 (27.5) | 11 (9.6) | 0.003 |
Hypertension | 21 (41.2) | 49 (42.6) | 0.863 |
Diabetes mellitus | 7 (13.7) | 30 (26.1) | 0.077 |
Chronic renal failure | 4 (7.8) | 9 (7.8) | 1.000 |
Witnessed | 41 (80.4) | 71 (62.3) | 0.021 |
Bystander CPR | 38 (74.5) | 73 (64.0) | 0.185 |
Shockable rhythm | 40 (78.4) | 31 (27.0) | <0.001 |
Cardiac etiology | 48 (94.1) | 56 (48.7) | <0.001 |
Time from arrest to ROSC, min, median (IQR) | 16.6 (9.0–20.0) | 36.7 (24.0–42.0) | <0.001 |
Target temperature, 33 °C | 45 (88.2) | 102 (88.7) | 0.932 |
ROSC-to-CT interval, min, median (IQR) | 26.0 (15.0–41.0) | 14.0 (10.0–29.0) | <0.001 |
GWR, mean ± SD | 1.23 ± 0.08 | 1.18 ± 0.07 | <0.001 |
Ventricular characteristics | |||
Distance between the anterior horns, mm | 37.1 (34.7–40.7) | 36.7 (34.3–40.9) | 0.993 |
Evans’ index | 0.277 (0.255–0.301) | 0.278 (0.260–0.308) | 0.525 |
Lateral diameter of TV, mm, median (IQR) | 6.0 (4.9–7.6) | 7.0 (5.0–8.9) | 0.072 |
Anteroposterior diameter of FV, mm, median (IQR) | 6.2 (4.9–7.8) | 6.5 (5.2–7.9) | 0.410 |
Ventricular volumetry | |||
LV, cm3, median (IQR) | 20.69 (13.32–28.20) | 25.93 (14.42–36.75) | 0.214 |
TV, cm3, median (IQR) | 1.02 (0.75–1.59) | 1.26 (0.65–1.73) | 0.919 |
FV, cm3, median (IQR) | 0.74 (0.68–0.99) | 0.58 (0.43–0.80) | <0.001 |
LV/TV, median (IQR) | 19.5 (14.9–23.2) | 22.6 (15.8–28.3) | 0.066 |
LV/FV, median (IQR) | 32.7 (16.1–38.7) | 44.5 (23.1–61.6) | 0.006 |
TV/FV, median (IQR) | 1.9 (0.9–2.0) | 2.1 (1.0–2.8) | 0.066 |
Cutoff | TP | FP | TN | FN | Sensitivity (95% CI) | Specificity (95% CI) | |
---|---|---|---|---|---|---|---|
GWR | <1.20 a | 68 | 14 | 37 | 47 | 59.1 (49.6–68.2) | 72.6 (58.3–84.1) |
<1.09 b | 10 | 0 | 51 | 105 | 8.7 (4.2–15.4) | 100.0 (93.0–100.0) | |
Distance between the anterior horns, mm | >39.4 a | 41 | 14 | 37 | 74 | 35.7 (26.9–45.1) | 72.6 (58.3–84.1) |
>47.5 b | 3 | 0 | 51 | 112 | 2.6 (0.5–7.4) | 100.0 (93.0–100.0) | |
Evans’ index | >0.297 a | 44 | 14 | 37 | 71 | 38.3 (29.4–47.8) | 72.6 (58.3–84.1) |
>0.357 b | 3 | 0 | 51 | 112 | 2.6 (0.5–7.4) | 100.0 (93.0–100.0) | |
Lateral diameter of TV, mm | >6.31 a | 73 | 19 | 32 | 42 | 63.5 (54.0–72.3) | 62.8 (48.1–75.9) |
>11.70 b | 5 | 0 | 51 | 110 | 4.4 (1.4–9.9) | 100.0 (93.0–100.0) | |
Anteroposterior diameter of FV | >6.97 a | 49 | 16 | 35 | 66 | 42.6 (33.4–52.2) | 68.6 (54.1–80.9) |
>11.08 b | 4 | 0 | 51 | 111 | 3.5 (1.0–8.7) | 100.0 (93.0–100.0) | |
Volume of LV, cm3 | >26.17 a | 57 | 14 | 37 | 58 | 49.6 (40.1–59.0) | 72.6 (58.3–84.1) |
<7.30 b | 9 | 0 | 51 | 106 | 7.8 (3.6–14.3) | 100.0 (93.0–100.0) | |
Volume of TV, cm3 | >1.34 a | 57 | 16 | 35 | 58 | 49.6 (40.1–59.0) | 68.6 (54.1–80.9) |
<0.49 b | 19 | 0 | 51 | 96 | 16.5 (10.3–24.6) | 100.0 (93.0–100.0) | |
Volume of FV, cm3 | <0.61 a | 66 | 8 | 43 | 49 | 57.4 (47.8–66.6) | 84.3 (71.4–93.0) |
<0.41 b | 24 | 0 | 51 | 91 | 20.9 (13.9–29.4) | 100.0 (93.0–100.0) | |
LV volume/FV volume | >38.7 a | 55 | 12 | 39 | 60 | 47.8 (38.4–57.3) | 76.5 (62.5–87.2) |
>119.5 b | 4 | 0 | 51 | 111 | 3.5 (1.0–8.7) | 100.0 (93.0–100.0) |
Univariable | Multivariable I a | Multivariable II b | ||||
---|---|---|---|---|---|---|
OR (95% CI) | p-Value | AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | |
Male | 0.64 (0.31–1.34) | 0.238 | 0.77 (0.32–1.87) | 0.571 | N.A. | |
Age, per year | 1.03 (1.01–1.05) | 0.012 | 1.04 (1.01–1.06) | 0.009 | N.A. | |
Nonshockable rhythm | 9.85 (4.50–21.59) | <0.001 | N.A. | 2.99 (0.79–11.26) | 0.107 | |
Noncardiac etiology | 16.86 (4.97–57.24) | <0.001 | N.A. | 15.26 (2.59–89.81) | 0.003 | |
Arrest time, per min | 1.10 (1.07–1.14) | <0.001 | N.A. | 1.13 (1.07–1.18) | <0.001 | |
ROSC to CT, per min | 1.00 (0.99–1.00) | 0.196 | 1.00 (0.99–1.00) | 0.666 | N.A. | |
GWR | ||||||
Quartile 1 | 5.10 (1.84–14.12) | 0.002 | 4.18 (1.37–12.73) | 0.012 | 1.13 (0.23–5.41) | 0.883 |
Quartile 2 | 4.46 (1.67–11.94) | 0.003 | 4.06 (1.34–12.36) | 0.014 | 1.90 (0.43–8.43) | 0.401 |
Quartile 3 | 1.89 (0.78–4.55) | 0.156 | 2.33 (0.85–6.42) | 0.102 | 1.66 (0.41–6.70) | 0.474 |
Quartile 4 | Ref. | Ref. | Ref. | |||
FV volume | ||||||
Quartile 1 | 5.64 (1.84–17.28) | 0.002 | 4.86 (1.42–16.70) | 0.012 | 1.82 (0.42–7.90) | 0.425 |
Quartile 2 | 3.91 (1.41–10.84) | 0.009 | 2.85 (0.92–8.82) | 0.069 | 4.55 (1.00–20.69) | 0.050 |
Quartile 3 | 0.78 (0.33–1.86) | 0.578 | 0.70 (0.27–1.87) | 0.481 | 0.28 (0.06–1.22) | 0.089 |
Quartile 4 | Ref. | Ref. | Ref. |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Gong, A.K.; Oh, S.H.; Jang, J.; Park, K.N.; Kim, H.J.; Lee, J.Y.; Youn, C.S.; Lim, J.Y.; Kim, H.J.; Bang, H.J., on behalf of CROWN Investigators. Prognostic Implication of Ventricular Volumetry in Early Brain Computed Tomography after Cardiac Arrest. Diagnostics 2024, 14, 1701. https://doi.org/10.3390/diagnostics14161701
Gong AK, Oh SH, Jang J, Park KN, Kim HJ, Lee JY, Youn CS, Lim JY, Kim HJ, Bang HJ on behalf of CROWN Investigators. Prognostic Implication of Ventricular Volumetry in Early Brain Computed Tomography after Cardiac Arrest. Diagnostics. 2024; 14(16):1701. https://doi.org/10.3390/diagnostics14161701
Chicago/Turabian StyleGong, Ae Kyung, Sang Hoon Oh, Jinhee Jang, Kyu Nam Park, Han Joon Kim, Ji Young Lee, Chun Song Youn, Jee Yong Lim, Hyo Joon Kim, and Hyo Jin Bang on behalf of CROWN Investigators. 2024. "Prognostic Implication of Ventricular Volumetry in Early Brain Computed Tomography after Cardiac Arrest" Diagnostics 14, no. 16: 1701. https://doi.org/10.3390/diagnostics14161701