Prediction of cerebral hyperperfusion after carotid endarterectomy using cerebral blood volume measured by perfusion-weighted MR imaging compared with single-photon emission CT.
Prediction of cerebral hyperperfusion after carotid endarterectomy using cerebral blood volume measured by perfusion-weighted MR imaging compared with single-photon emission CT.
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发表时间：
2007-04
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通讯作者：
T. Fukuda;K. Ogasawara;M. Kobayashi;Nobukazu Komoribayashi;H. Endo;Takashi Inoue;Y. Kuzu;H. Nishimoto;K. Terasaki;A. Ogawa
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作者：
T. Fukuda;K. Ogasawara;M. Kobayashi;Nobukazu Komoribayashi;H. Endo;Takashi Inoue;Y. Kuzu;H. Nishimoto;K. Terasaki;A. Ogawa
背景和目的脑高灌注综合征是颈动脉血运重建术中一种罕见但严重的并发症，包括颈动脉内膜切除术(CEA)和颈动脉支架置入术，可发生于术前脑血流动力学受损的患者。本研究的目的是确定术前用磁共振灌注成像(PWI)测量的脑血容量(CBV)是否能识别CEA术后有脑高灌注风险的患者。材料与方法对70例单侧颈内动脉(ICA)狭窄(或=70%)且无对侧颈内动脉狭窄闭塞病变的患者，在CEA前用PWI测量CBV。于CEA前、术后即刻及术后第3天用单光子发射CT测定脑血流量(CBF)。结果15例术前脑血流量升高的患者中，7例(47%)术前脑血流量与术后即刻脑血流量增加呈正相关(r=0.785，P或=100%)，术前脑血流量正常者术后无一例出现脑血流高灌注者。此外，术前CBV升高是CEA术后高灌注量的唯一显著独立预测因素。最后，在CEA术后立即出现高灌注者的7名患者中，有2名在术后第5天出现了高灌注症。结论术前PWI测定脑血流量有助于识别无对侧颈内动脉狭窄闭塞病变的CEA术后脑高灌注者。
BACKGROUND AND PURPOSE Cerebral hyperperfusion syndrome is a rare but serious complication of carotid revascularization, including carotid endarterectomy (CEA) and carotid stent placement, which can occur in patients with preoperative impairments in cerebral hemodynamics. The purpose of this study was to determine whether preoperative cerebral blood volume (CBV) measured by perfusion-weighted MR imaging (PWI) could identify patients at risk for cerebral hyperperfusion after CEA. MATERIALS AND METHODS CBV was measured by using PWI before CEA in 70 patients with unilateral internal carotid artery (ICA) stenosis (>or=70%) and without contralateral ICA steno-occlusive disease. Cerebral blood flow (CBF) was also measured by using single-photon emission CT before and immediately after CEA and on the 3rd postoperative day. RESULTS A significant correlation was observed between preoperative CBV and increases in CBF immediately after CEA (r = 0.785, P or=100% compared with preoperative values) was observed in 7 of 15 patients (47%) with elevated preoperative CBV, no patients with normal preoperative CBV exhibited post-CEA hyperperfusion. Furthermore, elevated preoperative CBV was the only significant independent predictor of post-CEA hyperperfusion. Finally, hyperperfusion syndrome developed on the 5th postoperative day in 2 of the 7 patients who displayed hyperperfusion immediately after CEA. CONCLUSION Measurements of preoperative CBV by PWI might help to identify patients at risk for cerebral hyperperfusion after CEA in the absence of contralateral ICA steno-occlusive disease.