{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:55:23Z","timestamp":1789088123792,"version":"build-2803163510"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2023R1A2C1006309"],"award-info":[{"award-number":["2023R1A2C1006309"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF- 2022R1I1A3063280"],"award-info":[{"award-number":["NRF- 2022R1I1A3063280"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diffusion-weighted magnetic resonance imaging (DW-MRI) within 0\u20136\u00a0h after return of spontaneous circulation can detect hypoxic-ischemic brain injury following out-of-hospital cardiac arrest (OHCA). Whether ultra-early findings differ by arrest etiology and how they should guide prognostication remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective cohort study of OHCA survivors who underwent ultra-early DW-MRI (0\u20136\u00a0h); a subset had follow-up scans (72\u201396\u00a0h). Etiology was classified as cardiac or respiratory. We assessed the prognostic performance of qualitative ultra-early high-signal-intensity (HSI) and quantitative ADC-R(650) (% brain voxels with ADC\u2009\u2264\u2009650\u2009\u00d7\u200910\u207b\u2076 mm\u00b2\/s) using receiver operating characteristic analysis to estimate the area under the curve (AUC) and sensitivity at 100% specificity. Qualitative HSI was based on routine clinical readings, with readers blinded to clinical outcomes and other clinical information. The primary outcome was poor neurological outcome at 6 months (CPC 3\u20135).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 176 patients (77 cardiac, 99 respiratory), 94 (53.4%) had poor outcomes. Ultra-early HSI occurred exclusively in patients with poor outcomes, yielding 100% specificity in both etiologies. At 100% specificity, sensitivity was significantly lower for respiratory etiology (52% vs. 86%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006). Ultra-early HSI predicted poor outcome (AUC 0.80), with higher discrimination in the cardiac etiology subgroup (0.93 vs. 0.76;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). In contrast, ultra-early ADC-R(650) showed modest prognostic value (AUC 0.77), but with similar discrimination between cardiac and respiratory etiology subgroups (0.80 vs. 0.77;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.71). In the follow-up subset (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009150), HSI demonstrated high discrimination for poor outcome (AUC 0.93) with no difference in AUC between cardiac and respiratory etiologies (0.96 vs. 0.95;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.57). At this later time point, ADC-R(650) demonstrated high prognostic performance (AUC 0.91), with comparable results across etiologies (0.89 vs. 0.93;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.47).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HSI on ultra-early DW-MRI is specific for poor outcome after OHCA, but sensitivity is lower in respiratory etiology. DW-MRI at 72\u201396\u00a0h provides prognostic performance independent of etiology. Following OHCA, ultra-early HSI may help phenotype patients, particularly those with cardiac etiology, supporting an etiology-aware staged approach to DW-MRI\u2013based prognostication. Further validation is warranted to explain delayed diffusion restriction in respiratory etiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-026-05939-5","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T08:44:43Z","timestamp":1772786683000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Etiology-specific prognostic value of ultra-early diffusion-weighted MRI after out-of-hospital cardiac arrest: a multicenter cohort study"],"prefix":"10.1186","volume":"30","author":[{"given":"Jin Hong","family":"Min","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeonho","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Soo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changshin","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Shik","family":"Ryu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wonjoon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se Kwang","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Young","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Ho","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Seon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Phil","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Beekman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Kook","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"5939_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.resuscitation.2021.12.026","volume":"171","author":"YH Chin","year":"2022","unstructured":"Chin YH, Yaow CYL, Teoh SE, Foo MZQ, Luo N, Graves N, et al. 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