Sakatani Kaoru, Yokose Noriaki, Katagiri Akihisa, Hoshino Tatsuya, Fujiwara Norio, Murata Yoshihiro, Hirayamama Teruyasu, Katayama Youichi
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Brain Nerve. 2011 Sep;63(9):955-61.
Various studies have demonstrated the usefulness of near infrared spectroscopy (NIRS) for detecting cerebral ischemia during a carotid endarterectomy; however, it is difficult to apply NIRS to the diagnosis of ischemic stroke, since commercially available NIRS, which uses continuous-wave light, does not provide quantitative values of baseline hemoglobin (Hb) concentrations. In contrast, time-resolved near-infrared spectroscopy (TRS) permits quantitative measurement of Hb concentrations. We applied TRS to detection of cerebra vasospasm after subarachnoid hemorrhage (SAH). We investigated 11 age-matched controls and 14 aneurysmal SAH patients that comprised 10 patients with World Federation of Neurological Societies (WFNS) grade V and 4 patients with WFNS grade II. Employing TR-NIRS, we measured the cortical oxygen saturation (CoSO2) and baseline Hb concentrations in the middle cerebral artery territory. The CoSO2 and Hb concentrations remained stable after SAH in 6 patients; digital subtraction angiography (DSA) did not reveal vasospasm in these patients. In 8 patients, however, CoSO2 and total Hb decreased abruptly between 5 and 9 days after SAH. DSA revealed diffuse vasospasms in 6 of 8 patients. The reduction of CoSO2 predicted occurrence of vasospasm at a cutoff value of 3.9%-6.4% with 100% sensitivity and 85.7% specificity. Trans cranial Doppler (TCD) failed to detect vasospasm in 4 cases, whereas TR-NIRS could. Finally, TRS performed on day 1 after SAH revealed significantly higher CoSO2 than that of the controls (p = 0.048), but there was no significant difference in total Hb. TRS detected vasospasm by evaluating the CBO in the cortex and may be more sensitive than TCD, which assesses the blood flow velocity in the M1 portion. TRS may be useful for the diagnosis of ischemic events in stroke patients.
多项研究已证明近红外光谱（NIRS）在颈动脉内膜切除术期间检测脑缺血方面的有用性；然而，将NIRS应用于缺血性中风的诊断很困难，因为市售的使用连续波光的NIRS无法提供基线血红蛋白（Hb）浓度的定量值。相比之下，时间分辨近红外光谱（TRS）允许对Hb浓度进行定量测量。我们将TRS应用于蛛网膜下腔出血（SAH）后脑血管痉挛的检测。我们调查了11名年龄匹配的对照组和14名动脉瘤性SAH患者，其中包括10名世界神经外科联合会（WFNS）V级患者和4名WFNS II级患者。使用TR-NIRS，我们测量了大脑中动脉区域的皮质氧饱和度（CoSO2）和基线Hb浓度。6例患者SAH后CoSO2和Hb浓度保持稳定；数字减影血管造影（DSA）显示这些患者无血管痉挛。然而，在8例患者中，SAH后5至9天CoSO2和总Hb突然下降。DSA显示8例患者中有6例出现弥漫性血管痉挛。CoSO2的降低预测血管痉挛的发生，截断值为3.9%-6.4%，敏感性为100%，特异性为85.7%。经颅多普勒（TCD）在4例病例中未能检测到血管痉挛，而TR-NIRS可以检测到。最后,SAH后第1天进行的TRS显示CoSO2明显高于对照组（p = 0.048），但总Hb无显著差异。TRS通过评估皮质中的CBO检测血管痉挛，可能比评估M1部分血流速度的TCD更敏感。TRS可能有助于诊断中风患者的缺血性事件。
