Balm R, van der Grond J, Mali W P, Eikelboom B C
Department of Vascular Surgery, University Hospital Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 1995 Aug;10(2):182-6. doi: 10.1016/s1078-5884(05)80109-1.
The purpose of this study was to evaluate the metabolic changes that occur in the human brain in patients with a symptomatic carotid artery stenosis.
N-acetyl-aspartate (NAA), choline, creatine and lactate were measured both before, and 4 days after, carotid endarterectomy, by magnetic resonance spectroscopic imaging (MRSI). Eight controls and 16 patients were examined. MRI and MRSI studies were performed on a Philips Gyroscan S15 whole body system operating at 1.5 Tesla. 1H spectra were selected from regions in the centrum semi-ovale outside areas showing white matter hyper intensities on MRI.
All patients showed a decrease of the NAA/choline and NAA/creatine ratio in the symptomatic hemisphere compared to the contralateral hemisphere and also compared to the controls. Lactate was present in some patients (5/16). After endarterectomy, the NAA/choline and NAA/creatine ratios increased significantly compared to the ratios preoperative. Lactate was absent or more than 50% reduced after the operation. MRSI showed metabolic changes in areas of the brain that did not show any abnormalities on MRI.
There are marked changes in brain metabolism in the symptomatic hemisphere of patients with a severe carotid artery stenosis. These metabolic changes normalise four days after endarterectomy.
本研究旨在评估有症状颈动脉狭窄患者大脑中发生的代谢变化。
通过磁共振波谱成像（MRSI）在颈动脉内膜切除术前及术后4天测量N-乙酰天门冬氨酸（NAA）、胆碱、肌酸和乳酸。对8名对照者和16名患者进行了检查。MRI和MRSI研究在一台运行于1.5特斯拉的飞利浦Gyroscan S15全身系统上进行。从MRI上显示白质高信号区域以外的半卵圆中心区域选取1H谱。
与对侧半球及对照组相比，所有患者的患侧半球NAA/胆碱和NAA/肌酸比值均降低。部分患者（5/16）存在乳酸。颈动脉内膜切除术后，NAA/胆碱和NAA/肌酸比值较术前显著升高。术后乳酸消失或减少超过50%。MRSI显示大脑中在MRI上未显示任何异常的区域存在代谢变化。
重度颈动脉狭窄患者患侧半球大脑代谢有明显变化。这些代谢变化在颈动脉内膜切除术后4天恢复正常。
