{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:36:06Z","timestamp":1760402166556,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Cardiopulmonary resuscitation (CPR) successfully restores systemic circulation approximately 50% of the time; however, many successfully restored patients have severe neurologic damage. In adults, the gray matter to white matter attenuation ratio (GWR) in brain computed tomography (CT) correlates with the neurologic outcome. However, in children, the clinical significance of GWR still remains unclear. The aim of this study was to evaluate the clinical characteristics of children who underwent CPR for cardiac arrest according to the survival and to demonstrate the differentiation of grey\/white matter by Hounsfield units of brain CT and to characterize the attenuations of grey and white matters. Methods: This is a retrospective single-center study. We enrolled those who underwent brain CT within 24 h after return of spontaneous circulation (ROSC) from January 2005 to June 2018. Brain CTs were taken within 24 h of ROSC. We measured the attenuation of grey and white matter in Hounsfield units and calculated GWR. They were compared with healthy controls. Patients were analyzed as follows: survivors vs. non-survivors and better neurologic outcome vs. worse neurologic outcome. Results: Among 100 pediatric patients who had CPR, 56 met inclusion criteria. There were 24 patients who survived and 32 non-survivors. Our study revealed that the incidence of seizure, duration of CPR, and instances of hypothermia were significantly different between survivors and non-survivors. In both survivors and non-survivors, the attenuation of the caudate nucleus, putamen, GWR-basal ganglia, and average GWR were significantly different from controls. In regression analyses, the medial cortex and average GWR were the significant variables to predict survival, and the receiver operating curves revealed areas under curve of 0.733 and 0.666, respectively. Also, the medial cortex 1 was the only variable that predicted the neurologic outcome. Conclusions: There was some predictive survival value of GWR and medial cortex at the centrum semiovale level in early brain CT within 24 h after cardiac arrest. Although we could not find the predictive value of GWR in the neurologic outcome of pediatric patients, we found that the absolute attenuation of the medial cortex was low in patients with worse neurologic outcomes. Further prospective, multicenter studies are needed to determine the predictive value of GWR and the medial cortex.<\/jats:p>","DOI":"10.3390\/children9010036","type":"journal-article","created":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T22:51:50Z","timestamp":1641250310000},"page":"36","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1200-9462","authenticated-orcid":false,"given":"Yun-Young","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Radiology, Chonnam National University Children\u2019s Hospital, Gwangju 61706, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Insu","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital and Medical School, Gwangju 61706, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung-Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, KS Hospital, Gwangju 62248, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2249-0667","authenticated-orcid":false,"given":"In-Seok","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju 61706, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Ok","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital and Medical School, Gwangju 61706, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Jong","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital and Medical School, Gwangju 61706, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2458-8529","authenticated-orcid":false,"given":"Hwa-Jin","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital and Medical School, Gwangju 61706, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1136\/hrt.82.6.674","article-title":"Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: The Utstein style applied to a midsized urban\/suburban area","volume":"82","author":"Grabner","year":"1999","journal-title":"Heart"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1148\/rg.282075066","article-title":"Hypoxic-ischemic brain injury: Imaging findings from birth to adulthood","volume":"28","author":"Huang","year":"2008","journal-title":"Radiographics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1212\/WNL.0000000000001742","article-title":"Early EEG contributes to multimodal outcome prediction of postanoxic coma","volume":"85","author":"Hofmeijer","year":"2015","journal-title":"Neurology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1136\/emj.2007.053306","article-title":"The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest","volume":"25","author":"Choi","year":"2008","journal-title":"Emerg. 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