PURPOSE The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognition and resting-state functional magnetic resonance imaging (rs-fMRI) using the Amplitude of Low Frequency Fluctuations (ALFF) technique. METHODS In this observational study, patients eligible for CEA were prospectively included. On the same day, within 1 week of the CEA procedure performed and 12 months after the CEA procedure, all patients underwent (i) an MRI examination for rs-fMRI analysis and (ii) a cognitive evaluation using the Italian version of the Mini-Mental State Examination (MMSE) corrected for age and schooling. Pre-CEA and post-CEA MMSE scores were evaluated using paired sample t-tests, adopting a p-value < 0.05 as statistical threshold. The ALFF technique was used for analyzing the differences between pre-CEA and post-CEA rs-fMRI scans in terms of regional neural activation. This was accomplished by applying non-parametric statistics based on randomization/permutation for cluster-level inferences, adopting a cluster-mass p-value corrected for false discovery < 0.05 for cluster threshold, and a p-uncorrected < 0.01 for the voxel threshold. RESULTS Twenty asymptomatic patients were enrolled. The mean MMSE score resulted improved following CEA procedure (p-value = 0.001). The ALFF analysis identified a single cluster of 6260 voxels of increased regional neural activity following CEA, and no cluster of reduced activity. The majority of voxels covered the right precentral gyrus, the right middle frontal gyrus, and the anterior division of the cingulate gyrus. CONCLUSION Mid-term cognitive improvements observed after CEA are associated to increased regional neural activity of several cerebral regions.

中文翻译：

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用低频波动幅度技术分析颈动脉内膜切除术对认知和区域神经活动的中期影响。

目的 本研究旨在使用低频波动幅度 (ALFF) 技术评估颈动脉内膜切除术 (CEA) 对认知和静息状态功能磁共振成像 (rs-fMRI) 的中期影响。方法 在这项观察性研究中，前瞻性纳入了符合 CEA 条件的患者。在同一天，在 CEA 手术后 1 周内和 CEA 手术后 12 个月内，所有患者都接受了 (i) MRI 检查以进行 rs-fMRI 分析和 (ii) 使用意大利版 Mini-精神状态检查 (MMSE) 针对年龄和教育程度进行了校正。使用配对样本 t 检验评估 CEA 前和 CEA 后 MMSE 分数，采用 p 值 < 0.05 作为统计阈值。ALFF 技术用于分析 CEA 前和 CEA 后 rs-fMRI 扫描在区域神经激活方面的差异。这是通过对集群级推断应用基于随机化/排列的非参数统计数据来实现的，采用集群质量 p 值校正错误发现 < 0.05 的集群阈值，以及未校正的 p 值 < 0.01 的体素阈值。结果 20 名无症状患者入组。平均 MMSE 得分在 CEA 程序后得到改善（p 值 = 0.001）。ALFF 分析确定了 CEA 后区域神经活动增加的 6260 个体素的单个集群，并且没有减少活动的集群。大多数体素覆盖右侧中央前回、右侧额中回和扣带回前部。