PREDICTION OF CEREBRAL HYPERPERFUSION AFTER CAROTID ENDARTERECTOMY USING MIDDLE CEREBRAL ARTERY SIGNAL INTENSITY IN PREOPERATIVE SINGLE-SLAB 3-DIMENSIONAL TIME-OF-FLIGHT MAGNETIC RESONANCE ANGIOGRAPHY
PREDICTION OF CEREBRAL HYPERPERFUSION AFTER CAROTID ENDARTERECTOMY USING MIDDLE CEREBRAL ARTERY SIGNAL INTENSITY IN PREOPERATIVE SINGLE-SLAB 3-DIMENSIONAL TIME-OF-FLIGHT MAGNETIC RESONANCE ANGIOGRAPHY
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DOI：
10.1227/01.neu.0000345941.99443.99
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发表时间：
2009-06-01
期刊：
影响因子：
4.8
通讯作者：
Ogawa, Akira
中科院分区：
文献类型：
--
作者：
Kuroda, Hiroki;Ogasawara, Kuniaki;Ogawa, Akira
目的：颈动脉内膜切除术(CEA)后有脑血流动力学损害的患者会发生脑高灌注。单层三维飞行时间磁共振血管成像(MRA)大脑中动脉(MCA)的信号强度可以评估大脑半球的血流动力学损害。方法：对81例同侧颈内动脉狭窄(<70%)患者术前行大脑中动脉MRA检查，根据显示大脑中动脉的能力，对CEA术后同侧大脑中动脉信号强度进行分级。在CEA术前、术后即刻和术后第3天应用单光子发射计算机断层扫描对脑血流量进行定量。结果：10例患者CEA术后即刻出现脑高灌注，脑血流量较术前增加100%。多因素分析显示，只有大脑中动脉信号强度降低与术后脑过度灌注量显著相关(95%可信区间，1.015~1.401；P=0.0319)。以大脑中动脉MRA信号强度降低为脑血流动力学损害时，MRA分级诊断CEA后高血流灌注的敏感性为100%，特异性为63%，阳性预测值为28%，阴性预测值为100%。10例CEA术后即刻出现高灌注者中有2例在术后第4天和第6天出现高灌注症。结论：通过这种简单的MRA方法评估大脑中动脉的信号强度，可以确定CEA后有脑过度灌注者的危险。
OBJECTIVE: Cerebral hyperperfusion after carotid endarterectomy (CEA) occurs in patients with preoperative impairments in cerebral hemodynamics. Signal intensity of the middle cerebral artery (MCA) on single-slab 3-dimensional time-of-flight magnetic resonance angiography (MRA) can assess hemodynamic impairment in the cerebral hemisphere. The purpose of the present study was to determine whether the signal intensity of the MCA on preoperative MRA could identify patients at risk for cerebral hyperperfusion after CEA.METHODS: The signal intensity of the MCA ipsilateral to CEA on preoperative MRA was graded according to the ability to visualize the MCA in 81 patients with ipsilateral internal carotid artery stenosis (>= 70%). Cerebral blood flow was also quantified using single-photon emission computed tomography before and immediately after CEA and on the third postoperative day.RESULTS: Cerebral hyperperfusion immediately after CEA (cerebral blood flow increase >= 100% compared with preoperative values) was observed in 10 patients. Multivariate analysis revealed that only reduced signal intensity of the MCA was significantly associated with the development of postoperative cerebral hyperperfusion (95% confidence interval, 1.015-1.401; P = 0.0319). When the reduced signal intensity of the MCA on MRA was defined as an impairment in cerebral hemodynamics, MRA grading resulted in 100% sensitivity and 63% specificity, with a 28% positive predictive value and a 100% negative predictive value for the development of post-CEA hyperperfusion. Hyperperfusion syndrome developed on the fourth and sixth postoperative days in 2 of the 10 patients who exhibited hyperperfusion immediately after CEA.CONCLUSION: Signal intensity of the MCA, as assessed by this simple MRA method, may identify patients at risk for post-CEA cerebral hyperperfusion.