Karaszewski Bartosz, Wardlaw Joanna M, Marshall Ian, Cvoro Vera, Wartolowska Karolina, Haga Kristin, Armitage Paul A, Bastin Mark E, Dennis Martin S
Department of Neurology of Adults, Medical University of Gdansk, Gdansk, Poland.
Ann Neurol. 2006 Oct;60(4):438-46. doi: 10.1002/ana.20957.
Pyrexia is associated with poor outcome after stroke, but the temperature changes in the brain after stroke are poorly understood. We used magnetic resonance spectroscopic imaging (water-to-N-acetylaspartate frequency shift) to measure cerebral temperature noninvasively in stroke patients.
We performed magnetic resonance diffusion, perfusion (diffusion- and perfusion-weighted imaging), and magnetic resonance spectroscopic imaging, compared temperatures in tissues as defined by the diffusion-weighted imaging appearance (definitely abnormal, possibly abnormal and immediately adjacent normal-appearing brain, and normal brain), and tested associations with lesion and patient characteristics.
Among 40 patients, temperature was higher in possibly abnormal (37.63 degrees C) than in definitely abnormal tissue (37.30 degrees C; p < 0.001) or in normal-appearing brain (ipsilateral, 37.16 degrees C; contralateral, 37.22 degrees C; both p < 0.001). Ischemic lesion temperature increased before normal brain temperature. Higher temperatures occurred in lesions that were large, had diffusion/perfusion-weighted imaging mismatch, had reduced cerebral blood flow, and in clinically severe strokes. Only 1 of 25 patients with ischemic lesion temperature greater than 37.5 degrees C was pyrexial.
Temperature is elevated in acutely ischemic brain. More work is required to determine whether raised temperature results from ischemic metabolic reactions, impaired heat exchange from reduced cerebral blood flow, or early inflammatory cell activity (or a combination of these), but magnetic resonance spectroscopic imaging could be used in studies of temperature after brain injury and to monitor interventions.
发热与卒中后不良预后相关，但卒中后脑内温度变化尚不清楚。我们使用磁共振波谱成像（水与N - 乙酰天门冬氨酸频率偏移）对卒中患者进行脑温的无创测量。
我们进行了磁共振扩散、灌注（扩散加权成像和灌注加权成像）以及磁共振波谱成像，比较了由扩散加权成像表现所定义的组织温度（明确异常、可能异常及紧邻的外观正常脑区、正常脑区），并测试了其与病灶及患者特征的相关性。
在40例患者中，可能异常组织的温度（37.63℃）高于明确异常组织（37.30℃；p < 0.001）或外观正常脑区（同侧37.16℃；对侧37.22℃；均p < 0.001）。缺血性病灶温度在正常脑温之前升高。在大病灶、有扩散/灌注加权成像不匹配、脑血流量减少的病灶以及临床严重卒中患者中出现较高温度。25例缺血性病灶温度高于37.5℃的患者中只有1例发热。
急性缺血性脑内温度升高。需要更多研究来确定温度升高是由于缺血代谢反应、脑血流量减少导致的热交换受损，还是早期炎症细胞活动（或这些因素的组合），但磁共振波谱成像可用于脑损伤后温度研究及监测干预措施。
