Shibukawa Shuhei, Konta Natsuo, Niwa Tetsu, Miyati Tosiaki, Yonemochi Takuya, Yoshimaru Daisuke, Horie Tomohiko, Kuroda Kagayaki, Sorimachi Takatoshi
Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Tokyo, Japan; Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Meguro-ku, Tokyo, Japan; Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan.
Magn Reson Imaging. 2023 Jun;99:1-6. doi: 10.1016/j.mri.2022.12.027. Epub 2023 Jan 3.
Brain temperature monitoring using a catheter thermometer has been reported to be a useful technique to predict prognosis in neurosurgery. To investigate the possibility of measuring intracranial cerebrospinal fluid temperature for postoperative monitoring in patients with Moyamoya disease (MMD) after bypass surgery.
This study evaluated fifteen patients with MMD who were indicated for bypass surgery. Diffusion tensor imaging for brain thermometry were performed on a 1.5-T MR scanner. Intracranial cerebrospinal fluid temperature with/without considering the fractional anisotropy component, body temperature, C-reactive protein levels, white blood cell count, and cerebral blood flow measured by I-IMP single-photon emission computed tomography were obtained before surgery and 1-3 days after surgery. Pixel values considered to be signal outliers in fractional anisotropy processing were defined as cerebrospinal fluid noise index and calculated. Wilcoxon signed-rank test and effect size were performed to compare the changes before and after revascularization. Spearman's rho correlation coefficient was used to analyze the correlations between each parameter. Statistical significance was defined as p < 0.05.
All parameter values became significantly higher compared to those measured before revascularization (p < 0.01 in all cases). The effect sizes were largest for the cerebrospinal fluid temperature with fractional anisotropy processing and for C-reactive protein levels (Rank-biserial correlation = 1.0). The cerebrospinal fluid noise index and cerebrospinal fluid temperatures with fractional anisotropy processing (r = 0.84, p < 0.0001) or without fractional anisotropy processing (r = 0.95, p < 0.0001) showed highly significant positive correlations. Although no significant correlation was observed, cerebrospinal fluid temperatures with fractional anisotropy had small or moderately positive correlations with cerebral blood flow, body temperature, C-reactive protein levels, and white blood cell count (r = 0.37, 0.42, 0.41, and 0.44, respectively; p > 0.05).
Our findings suggest the possibility of postoperative monitoring for MMD patients by measuring intracranial cerebrospinal fluid temperature with fractional anisotropy processing. Intracranial cerebrospinal fluid temperature might be considered as combined response since cerebrospinal fluid, body temperature, and inflammation are equally correlated.
据报道，使用导管温度计监测脑温是预测神经外科手术预后的一项有用技术。本研究旨在探讨在烟雾病（MMD）患者旁路手术后测量颅内脑脊液温度用于术后监测的可能性。
本研究评估了15例拟行旁路手术的MMD患者。在1.5-T磁共振成像扫描仪上进行用于脑温测量的扩散张量成像。在手术前及术后1-3天获取颅内脑脊液温度（考虑或不考虑分数各向异性成分）、体温、C反应蛋白水平、白细胞计数以及通过I-IMP单光子发射计算机断层扫描测量的脑血流量。将分数各向异性处理中被视为信号异常值的像素值定义为脑脊液噪声指数并进行计算。采用Wilcoxon符号秩检验和效应量来比较血运重建前后的变化。使用Spearman等级相关系数分析各参数之间的相关性。统计学显著性定义为p < 0.05。
与血运重建前测量的值相比，所有参数值均显著升高（所有情况p < 0.01）。对于考虑分数各向异性处理的脑脊液温度和C反应蛋白水平，效应量最大（等级双列相关 = 1.0）。考虑分数各向异性处理的脑脊液噪声指数与脑脊液温度（r = 0.84，p < 0.0001）或不考虑分数各向异性处理的脑脊液温度（r = 0.95，p < 0.0001）显示出高度显著的正相关。尽管未观察到显著相关性，但考虑分数各向异性的脑脊液温度与脑血流量、体温、C反应蛋白水平和白细胞计数存在小或中等程度的正相关（分别为r = 0.37、0.42、0.41和0.44；p > 0.05）。
我们的研究结果表明，通过考虑分数各向异性处理测量颅内脑脊液温度，有可能对MMD患者进行术后监测。由于脑脊液、体温和炎症具有同等相关性，颅内脑脊液温度可被视为综合反应。
