Postcarotid Endarterectomy Improvement in Cognition Is Associated with Resolution of Crossed Cerebellar Hypoperfusion and Increase in 123I-Iomazenil Uptake in the Cerebral Cortex: A SPECT Study
Postcarotid Endarterectomy Improvement in Cognition Is Associated with Resolution of Crossed Cerebellar Hypoperfusion and Increase in 123I-Iomazenil Uptake in the Cerebral Cortex: A SPECT Study
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DOI：
10.1159/000278930
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发表时间：
2010-01-01
影响因子：
2.9
通讯作者：
Ogawa, Akira
中科院分区：
文献类型：
--
作者：
Chida, Kohei;Ogasawara, Kuniaki;Ogawa, Akira
背景：本研究的目的是探讨颈动脉内膜切除术(CEA)后交叉性小脑低灌注(CCH)的缓解和同侧大脑皮质I-123-Iomazenil(IMZ)摄取的增加是否与术后认知功能的改善有关。方法：对79例同侧颈内动脉狭窄(<70%)行颈总动脉CEA术前及术后1个月进行神经心理测试。术前、术后分别行N-异丙基-p-I-123-碘苯丙胺脑灌注单光子发射计算机断层扫描(SPECT)和I-123-IMZ脑SPECT检查。使用三维立体定位感兴趣区模板分析数据。结果：术后认知功能改善7例(9%)。7例患者术后均显示同侧大脑皮质血流量增加，脑出血消失。5名患者(6%)术后大脑半球I-123-IMZ摄取增加，这5名患者的认知功能均有改善。受试者操作特征(ROC)曲线的分析被用来评估区分术后认知改善和不改善的患者的能力。分析脑出血患者术后脑出血消退程度(0.991；95%CI 0.984~1.001)或大脑半球I-123-IMZ摄取增加幅度(0.981；95%CI 0.972~0.999)时，ROC曲线下面积明显大于术后脑血流增加幅度(0.929；95%CI 0.886~0.971)(p<；0.05)。结论：CEA术后同侧大脑皮质CCH消退和I-123-IMZ摄取增加与术后认知功能改善有关。这些结果可能表明，认知障碍可能与大脑皮质对短暂性脑缺血发作或轻微卒中的反应中中枢苯二氮卓类受体下调的状态有关。版权所有(C)2010 S.Karger AG，巴塞尔
Background: The purpose of the present study was to investigate whether resolution of crossed cerebellar hypoperfusion (CCH) and increase in I-123-iomazenil (IMZ) uptake in the ipsilateral cerebral cortex after carotid endarterectomy (CEA) are associated with postoperative improvement of cognitive function. Methods: Neuropsychological testing was performed preoperatively and after 1 postoperative month in 79 patients undergoing CEA for ipsilateral internal carotid artery stenosis (>= 70%). Brain perfusion single photon emission computed tomography (SPECT) using N-isopropyl-p-I-123-iodoamphetamine and I-123-IMZ SPECT were also performed before and after surgery. Data were analyzed using a three-dimensional stereotaxic region of interest template. Results: Seven patients (9%) showed improvement in postoperative cognitive function. All the 7 patients exhibited both postoperative increase in blood flow in the ipsilateral cerebral cortex and resolution of CCH. Five patients (6%) had a postoperative hemispheric increase in I-123-IMZ uptake, and cognitive function improved in all of these 5 patients. Analysis by a receiver operating characteristic (ROC) curve was used to estimate the ability to discriminate between patients with and without postoperative cognitive improvement. The area under the ROC curve was significantly greater when analyzing the magnitude of postoperative resolution of CCH (0.991; 95% CI 0.984-1.001) or postoperative hemispheric increase in I-123-IMZ uptake (0.981; 95% CI 0.972-0.999) when compared with the magnitude of postoperative increase in cerebral blood flow (0.929; 95% CI 0.886-0.971) (p < 0.05). Conclusions: Resolution of CCH and increase in I-123-IMZ uptake in the ipsilateral cerebral cortex after CEA is associated with postoperative improvement in cognitive function. These results may indicate that cognitive impairment is related to a state of potentially reversible central benzodiazepine receptor downregulation in the cortex in response to transient ischemic attack or minor stroke. Copyright (C) 2010 S. Karger AG, Basel