Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA.
Psychooncology. 2013 Sep;22(9):2087-94. doi: 10.1002/pon.3262. Epub 2013 Mar 4.
Post-operative delirium is associated with pre-operative cognitive difficulties and diminished functional independence, both of which suggest that brain pathology may be present in affected individuals prior to surgery. Currently, there are few studies that have examined imaging correlates of post-operative delirium. To our knowledge, none have examined the association of delirium with existing structural pathology in pre-operative cancer patients. Here, we present a novel, retrospective strategy to assess pre-operative structural brain pathology and its association with post-operative delirium. Standard of care structural magnetic resonance imaging (MRIs) from a cohort of surgical candidates prior to surgery were analyzed for white matter hyperintensities and cerebral atrophy.
We identified 23 non-small cell lung cancer patients with no evidence of metastases in the brain pre-operatively, through retrospective chart review, who met criteria for post-operative delirium within 4 days of surgery. 24 age- and gender-matched control subjects were identified for comparison to the delirium sample. T1 and fluid-attenuated inversion recovery sequences were collected from standard of care pre-operative MRI screening and assessed for white matter pathology and atrophy.
We found significant differences in white matter pathology between groups with the delirium group exhibiting significantly greater white matter pathology than the non-delirium group. Measure of cerebral atrophy demonstrated no significant difference between the delirium and non-delirium group.
In this preliminary study utilizing standard of care pre-operative brain MRIs for assessment of structural risk factors to delirium, we found white matter pathology to be a significant risk factor in post-operative delirium. Limitations and implications for further investigation are discussed.
术后谵妄与术前认知困难和功能独立性下降有关，这两者都表明在受影响的个体手术前可能存在脑部病理。目前，很少有研究检查术后谵妄的影像学相关性。据我们所知，没有研究检查谵妄与术前癌症患者现有结构病理学之间的关系。在这里，我们提出了一种新颖的、回顾性策略来评估术前结构性脑病理学及其与术后谵妄的关系。在手术前对手术候选者进行了标准护理结构磁共振成像（MRI）分析，以评估白质高信号和脑萎缩。
我们通过回顾性病历审查，确定了 23 名术前无脑转移证据的非小细胞肺癌患者，这些患者符合术后 4 天内发生谵妄的标准。为了与谵妄样本进行比较，确定了 24 名年龄和性别匹配的对照受试者。从标准护理术前 MRI 筛查中收集 T1 和液体衰减反转恢复序列，并评估白质病理学和萎缩。
我们发现两组之间的白质病理学存在显著差异，谵妄组的白质病理学明显高于非谵妄组。脑萎缩的测量值在谵妄组和非谵妄组之间没有显著差异。
在这项利用标准护理术前脑 MRI 评估谵妄结构风险因素的初步研究中，我们发现白质病理学是术后谵妄的一个重要危险因素。讨论了局限性和进一步研究的意义。
