Neurological Research ( IF 1.9 ) Pub Date : 2020-11-15 , DOI: 10.1080/01616412.2020.1847529 Hidenori Endo 1, 2, 3 , Miki Fujimura 1, 4 , Atsushi Saito 1, 4 , Toshiki Endo 1, 2 , Kazumasa Ootomo 5 , Teiji Tominaga 2
ABSTRACT
Introduction: Cerebral hyperperfusion (CHP) syndrome is one of the most deleterious complications after carotid endarterectomy (CEA). Arterial spin labeling (ASL) is a promising non-invasive method to evaluate various hemodynamic parameters in cerebrovascular diseases. The aim of this study was to clarify whether ASL with multiple post-labeling delays (PLDs) can predict postoperative CHP after CEA.
Methods: Sixty-one patients with carotid artery stenosis treated by CEA were retrospectively analyzed. The asymmetry index of the preoperative CBF was obtained from ASL using 3 PLDs (1525 ms, 2025 ms, and 2525 ms) and single-photon emission computed tomography (SPECT). Cerebrovascular reactivity (CVR) was measured from SPECT with acetazolamide challenge. The slope of the regression line obtained from the asymmetry index of three PLDs was defined as the slope index.
Results: The CHP phenomenon was observed in seven patients (11.5%), one of whom developed CHP syndrome (1.6%). Using the CHP phenomenon as a reference standard, the area under the receiver operating characteristics (ROC) was 0.68 for the asymmetry index of the preoperative SPECT, 0.71 for the asymmetry index of the preoperative ASL,0.73 for CVR, and 0.78 for the slope index. Using the cutoff value obtained by ROC analysis, the slope index demonstrated a sensitivity of 85%, specificity of 74%, positive predictive value of 30% and the negative predictive value of 98% for predicting CHP.
Conclusions: The slope index calculated by ASL with multiple PLDs is a useful screening tool to predict postoperative CHP after CEA.
中文翻译:
多次标记后延迟的动脉自旋标记磁共振成像预测颈动脉内膜切除术后脑高灌注的疗效
摘要
简介:脑过度灌注(CHP)综合征是颈动脉内膜切除术(CEA)后最有害的并发症之一。动脉自旋标记 (ASL) 是一种有前途的非侵入性方法,用于评估脑血管疾病中的各种血流动力学参数。本研究的目的是阐明具有多个标记后延迟 (PLD) 的 ASL 是否可以预测 CEA 后的术后 CHP。
方法:对61例经CEA治疗的颈动脉狭窄患者进行回顾性分析。使用 3 个 PLD(1525 ms、2025 ms 和 2525 ms)和单光子发射计算机断层扫描 (SPECT) 从 ASL 获得术前 CBF 的不对称指数。脑血管反应性 (CVR) 是从 SPECT 与乙酰唑胺激发测量的。将从三个PLD的不对称指数得到的回归线的斜率定义为斜率指数。
结果: 7 名患者(11.5%)观察到 CHP 现象,其中 1 名患者出现 CHP 综合征(1.6%)。以CHP现象为参考标准,术前SPECT不对称指数ROC为0.68,术前ASL不对称指数为0.71,CVR为0.73,斜率指数为0.78 . 使用 ROC 分析获得的截止值,斜率指数显示出预测 CHP 的敏感性为 85%,特异性为 74%,阳性预测值为 30%,阴性预测值为 98%。
结论:通过 ASL 与多个 PLD 计算的斜率指数是预测 CEA 术后 CHP 的有用筛选工具。