Diffusion-weighted MRI: detection of cerebral ischemia before and after carotid thromboendarterectomy.
OBJECTIVE
Conventional postoperative evaluation of patients following carotid thromboendarterectomy (TEA) consists of a clinical neurologic examination to assess neurologic deficits, color duplex ultrasound to document the surgically reestablished patency of the carotid artery, and CT for exclusion of postoperative ischemic infarctions. Recent studies prove that diffusion-weighted MRI is more sensitive in the detection of fresh insults than conventional MRI and CT. The objective of the study was to ascertain the incidence of clinically asymptomatic peri-and postoperative ischemic infarctions visualized at MRI.


METHODS
We included 52 patients in the study. Fifty-one patients (31 men, 20 women; average age 68 years) underwent cranial MR examination including a diffusion-weighted sequence at 24 h prior to carotid TEA and again 24 h following the procedure. One patient did not agree to participate.


RESULTS
In 29 of 51 patients (56%), neither the pre-nor the postoperative MR scans showed any diffusion abnormalities. In 16 patients (31%), however, preoperative MRI detected fresh ischemic insults. In nine patients (17.6%), the size of the insult resulted in surgery being postponed for 4 weeks. In six patients (11.8%), postoperative MRI returned findings of fresh disturbances of diffusion suggestive of ischemia that were not visualized on preoperative scans. Discrete neurologic deficits were observed in only two (3.9%) of these patients. Deficits were transient and disappeared within 72 h.


CONCLUSIONS
Our findings underscore MRI's capacity for visualizing perioperative ischemic events. Moreover, MRI provides evidence of clinically asymptomatic embolisms that occur perioperatively.
Department of Radiology, University of Ulm, Ulm, Germany. reinhard.tomczak@t-online.de
R
R
Tomczak
A
A
Wunderlich
F
F
Liewald
G
G
Stuber
J
J
Görich
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D003287:Contrast Media; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA