Brain Temperature Measured by Using Proton MR Spectroscopy Predicts Cerebral Hyperperfusion after Carotid Endarterectomy
Brain Temperature Measured by Using Proton MR Spectroscopy Predicts Cerebral Hyperperfusion after Carotid Endarterectomy
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DOI：
10.1148/radiol.10090930
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发表时间：
2010-09-01
期刊：
影响因子：
19.7
通讯作者：
Ogawa, Akira
中科院分区：
文献类型：
--
作者：
Murakami, Toshiyuki;Ogasawara, Kuniaki;Ogawa, Akira
目的：为了确定是否使用术前质子磁共振（MR）光谱测量脑温度可以帮助识别患者的危险脑灌注过度颈动脉内膜切除术（CEA）后，材料和方法：机构审查委员会批准和知情同意书。在84例单侧颈内动脉狭窄（>= 70%）且对侧颈内动脉无狭窄闭塞性疾病的患者的双侧大脑半球中，在CEA前使用无水抑制的点分辨波谱法进行质子MR波谱数据采集。根据质子MR波谱中水和N-乙酰天冬氨酸信号之间的化学位移差计算脑温度。在CEA术前、术后即刻和术后第3天，使用单光子发射计算机断层扫描和N-异丙基-p-[I-123]-碘苯丙胺测量脑血流量（CBF）。各变量与CEA后高灌注发展的关系（与术前值相比CBF增加>= 100%）通过单变量统计分析进行评估，然后进行多变量分析。术前脑温差与脑缺血再灌注损伤程度呈线性相关，（受影响半球的值减去对侧半球的值），并在CEA后立即增加CBF（r = 0.763和P < .001）当术前脑温差大于0. 9例患者（11%）在CEA后立即观察到脑灌注过度。升高的术前脑温差是CEA术后高灌注的唯一显著独立预测因子。当升高的脑温差被定义为受影响大脑半球血流动力学损害的标志物时，使用术前脑温差导致100%的灵敏度和87%的特异性，预测CEA后高灌注的阳性预测值为47%，阴性预测值为100%。高灌注综合征的第3和第4天，在9例患者表现出高灌注后立即CEA.Conclusion：脑温度测量使用术前质子磁共振波谱可以帮助确定患者的风险后CEA脑灌注过多。(C)RSNA，2010年
Purpose: To determine whether brain temperature measured by using preoperative proton magnetic resonance (MR) spectroscopy could help identify patients at risk for cerebral hyperperfusion after carotid endarterectomy (CEA).Materials and Methods: Institutional review board approval and informed consent were obtained. Acquisition of proton MR spectroscopic data by using point-resolved spectroscopy without water suppression was performed before CEA in the bilateral cerebral hemispheres of 84 patients with unilateral internal carotid artery stenosis (>= 70%) and without contralateral internal carotid artery steno-occlusive disease. Brain temperature was calculated from the chemical shift difference between water and N-acetylaspartate signals at proton MR spectroscopy. Cerebral blood flow (CBF) was also measured by using single photon emission computed tomography and N-isopropyl-p-[I-123]-iodoamphetamine before and immediately after CEA and on the 3rd postoperative day. The relationship between each variable and the development of post-CEA hyperperfusion (CBF increase >= 100% compared with preoperative values) was evaluated with univariate statistical analysis followed by multivariate analysis.Results: A linear correlation was observed between preoperative brain temperature difference (the value in the affected hemisphere minus the value in the contralateral hemisphere) and increases in CBF immediately after CEA (r = 0.763 and P < .001) when the preoperative brain temperature difference was greater than 0. Cerebral hyperperfusion immediately after CEA was observed in nine patients (11%). Elevated preoperative brain temperature difference was the only significant independent predictor of post-CEA hyperperfusion. When elevated brain temperature difference was defined as a marker of hemodynamic impairment in the affected cerebral hemisphere, use of preoperative brain temperature difference resulted in 100% sensitivity and 87% specificity, with a 47% positive predictive value and a 100% negative predictive value for the prediction of post-CEA hyperperfusion. Hyperperfusion syndrome developed on the 3rd and 4th postoperative days in two of the nine patients who exhibited hyperperfusion immediately after CEA.Conclusion: Brain temperature measured by using preoperative proton MR spectroscopy may help identify patients at risk for post-CEA cerebral hyperperfusion. (C) RSNA, 2010