Preoperative brain temperature imaging on proton magnetic resonance spectroscopy predicts hemispheric ischemia during carotid endarterectomy for unilateral carotid stenosis with inadequate collateral blood flow
Preoperative brain temperature imaging on proton magnetic resonance spectroscopy predicts hemispheric ischemia during carotid endarterectomy for unilateral carotid stenosis with inadequate collateral blood flow
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DOI：
10.1080/01616412.2018.1457130
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发表时间：
2018-01-01
影响因子：
1.9
通讯作者：
Ogasawara, Kuniaki
中科院分区：
文献类型：
--
作者：
Tsutsui, Shouta;Nanba, Takamasa;Ogasawara, Kuniaki
目的：术前磁共振 (MR) 血管造影有时显示没有经过 Willis 环的侧支血流。本研究检验了多体素质子磁共振波谱的脑温度 (BT) 成像是否可以提高在有症状的单侧颈动脉狭窄患者的颈内动脉 (ICA) 夹闭期间预测半球缺血的准确性。方法：在 52 名患有 ICA 狭窄 (>= 70%) 且缺乏通过 Willis 环的侧支血流的患者中 在术前 MR 血管造影中，使用质子多体素 MR 波谱显示 BT 成像。计算半卵圆中心深部白质中受影响半球和对侧半球的 BT 之间的差异（BT 受影响半球 - BT 对侧半球），并将其定义为半球 Delta BT。通过术中脑电图 (EEG) 确定 ICA 钳夹期间大脑半球缺血的发生情况。结果：多变量分析显示，术前高的半球 Delta BT 与 EEG 定义的半球缺血的发生显着相关（95% 置信区间 [CIs]，5.376-15.452；p=0.006）。术前 MR 血管造影后进行术前半球 Delta BT (95% CI, 42-87%) 的脑电图定义的半球缺血发展的阳性预测值显着高于术前 MR 血管造影 (95% CI, 13-37%)。结论：对于没有通过 Willis 环的侧支血流的患者，BT 成像提高了预测准确性 用于 CEA 期间 ICA 钳夹期间半球缺血的发生。
Objective: Preoperative magnetic resonance (MR) angiography sometimes shows the absence of collateral flow via the circle of Willis. This study examined whether brain temperature (BT) imaging on multi-voxel proton MR spectroscopy after this finding increases the accuracy of predicting hemispheric ischemia during internal carotid artery (ICA) clamping during endarterectomy for patients with symptomatic unilateral carotid stenosis.Methods: In 52 patients with ICA stenosis (>= 70%) and absence of collateral blood flow via the circle of Willis on preoperative MR angiography, BT imaging was displayed using proton multi-voxel MR spectroscopy. The difference between BTs in the affected and contralateral hemispheres (BTaffected hemisphere - BTcontralateral hemisphere) in the deep white matter of the centrum semiovale was calculated and defined as hemispheric Delta BT. Development of cerebral hemispheric ischemia during ICA clamping was determined from intraoperative electroencephalography (EEG).Results: Multivariate analysis revealed that high preoperative hemispheric Delta BT was significantly associated with development of EEG-defined hemispheric ischemia (95% confidence intervals [CIs], 5.376-15.452; p=0.006). The positive-predictive value for development of EEG-defined hemispheric ischemia was significantly greater for preoperative hemispheric Delta BT following preoperative MR angiography (95%CI, 42-87%) than for preoperative MR angiography alone (95%CI, 13-37%).Conclusions: For patients without collateral flow via the circle of Willis, BT imaging increases the predictive accuracy for development of hemispheric ischemia during ICA clamping during CEA.