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Brain temperature measured by using proton MR spectroscopy predicts cerebral hyperperfusion after carotid endarterectomy Murakami T; Ogasawara K; Yoshioka Y; Ishigaki D; Sasaki M; Kudo K; Aso K; Nishimoto H; Kobayashi M; Yoshida K; Ogawa ARadiology 2010[Sep]; 256 (3): 924-31PURPOSE: To determine whether brain temperature measured by using preoperative proton magnetic resonance (MR) spectroscopy could help identify patients at risk for cerebral hyperperfusion after carotid endarterectomy (CEA). MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. Acquisition of proton MR spectroscopic data by using point-resolved spectroscopy without water suppression was performed before CEA in the bilateral cerebral hemispheres of 84 patients with unilateral internal carotid artery stenosis (> or =70%) and without contralateral internal carotid artery steno-occlusive disease. Brain temperature was calculated from the chemical shift difference between water and N-acetylaspartate signals at proton MR spectroscopy. Cerebral blood flow (CBF) was also measured by using single photon emission computed tomography and N-isopropyl-p-[(123)I]-iodoamphetamine before and immediately after CEA and on the 3rd postoperative day. The relationship between each variable and the development of post-CEA hyperperfusion (CBF increase > or = 100% compared with preoperative values) was evaluated with univariate statistical analysis followed by multivariate analysis. RESULTS: A linear correlation was observed between preoperative brain temperature difference (the value in the affected hemisphere minus the value in the contralateral hemisphere) and increases in CBF immediately after CEA (r = 0.763 and P < .001) when the preoperative brain temperature difference was greater than 0. Cerebral hyperperfusion immediately after CEA was observed in nine patients (11%). Elevated preoperative brain temperature difference was the only significant independent predictor of post-CEA hyperperfusion. When elevated brain temperature difference was defined as a marker of hemodynamic impairment in the affected cerebral hemisphere, use of preoperative brain temperature difference resulted in 100% sensitivity and 87% specificity, with a 47% positive predictive value and a 100% negative predictive value for the prediction of post-CEA hyperperfusion. Hyperperfusion syndrome developed on the 3rd and 4th postoperative days in two of the nine patients who exhibited hyperperfusion immediately after CEA. CONCLUSION: Brain temperature measured by using preoperative proton MR spectroscopy may help identify patients at risk for post-CEA cerebral hyperperfusion.|*Body Temperature[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Blood Volume[MESH]|Carotid Stenosis/*surgery[MESH]|Cerebrovascular Circulation/*physiology[MESH]|Chi-Square Distribution[MESH]|Endarterectomy, Carotid/*adverse effects[MESH]|Female[MESH]|Humans[MESH]|Magnetic Resonance Spectroscopy/*methods[MESH]|Male[MESH]|Middle Aged[MESH]|Predictive Value of Tests[MESH]|Protons[MESH]|ROC Curve[MESH]|Risk Factors[MESH]|Sensitivity and Specificity[MESH]|Statistics, Nonparametric[MESH]|Tomography, Emission-Computed, Single-Photon[MESH] |
