Tsutsui Shouta, Nanba Takamasa, Yoshioka Yoshichika, Sasaki Makoto, Fujiwara Shunrou, Kobayashi Masakazu, Yoshida Kenji, Miyoshi Kenya, Sato Shinpei, Ogasawara Kuniaki
a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
b Open and Transdisciplinary Research Initiatives , Osaka University , Suita , Japan.
Neurol Res. 2018 Aug;40(8):617-623. doi: 10.1080/01616412.2018.1457130. Epub 2018 Mar 30.
Objective Preoperative magnetic resonance (MR) angiography sometimes shows the absence of collateral flow via the circle of Willis. This study examined whether brain temperature (BT) imaging on multi-voxel proton MR spectroscopy after this finding increases the accuracy of predicting hemispheric ischemia during internal carotid artery (ICA) clamping during endarterectomy for patients with symptomatic unilateral carotid stenosis. Methods In 52 patients with ICA stenosis (≥70%) and absence of collateral blood flow via the circle of Willis on preoperative MR angiography, BT imaging was displayed using proton multi-voxel MR spectroscopy. The difference between BTs in the affected and contralateral hemispheres (BT - BT) in the deep white matter of the centrum semiovale was calculated and defined as hemispheric ΔBT. Development of cerebral hemispheric ischemia during ICA clamping was determined from intraoperative electroencephalography (EEG). Results Multivariate analysis revealed that high preoperative hemispheric ΔBT was significantly associated with development of EEG-defined hemispheric ischemia (95% confidence intervals [CIs], 5.376-15.452; p = 0.006). The positive-predictive value for development of EEG-defined hemispheric ischemia was significantly greater for preoperative hemispheric ΔBT following preoperative MR angiography (95%CI, 42-87%) than for preoperative MR angiography alone (95%CI, 13-37%). Conclusions For patients without collateral flow via the circle of Willis, BT imaging increases the predictive accuracy for development of hemispheric ischemia during ICA clamping during CEA.
目的 术前磁共振（MR）血管造影有时显示通过 Willis 环的侧支血流缺失。本研究探讨在此发现后，多体素质子 MR 波谱上的脑温（BT）成像是否能提高对有症状单侧颈动脉狭窄患者在颈动脉内膜切除术期间夹闭颈内动脉（ICA）时半球缺血预测的准确性。方法 对 52 例 ICA 狭窄（≥70%）且术前 MR 血管造影显示通过 Willis 环无侧支血流的患者，使用质子多体素 MR 波谱显示 BT 成像。计算半卵圆中心深部白质中患侧和对侧半球的 BT 差值（BT - BT），并定义为半球ΔBT。通过术中脑电图（EEG）确定 ICA 夹闭期间脑半球缺血的发生情况。结果 多因素分析显示，术前高半球ΔBT 与 EEG 定义的半球缺血的发生显著相关（95%置信区间[CI]，5.376 - 15.452；p = 0.006）。术前 MR 血管造影后，术前半球ΔBT 对 EEG 定义的半球缺血发生的阳性预测值显著高于单独术前 MR 血管造影（95%CI，42 - 87%比 95%CI，13 - 37%）。结论 对于通过 Willis 环无侧支血流的患者，BT成像可提高颈动脉内膜剥脱术期间ICA夹闭时半球缺血发生的预测准确性。
