title: Diffusion-weighted magnetic resonance imaging lesions after repair of acute type A aortic dissection: association with neurocognitive outcomes†‡.
abstract: OBJECTIVE
  We sought to analyse the preoperative status of arch vessels by postoperative diffusion-weighted magnetic resonance imaging (DWI) as a potential surrogate marker for cerebral thromboembolism and its relationship to neurocognitive outcomes.
  
  
  METHODS
  Preoperative computed tomography (CT) and postoperative DWI were available for 50 patients who received surgery for acute type A aortic dissection. Two radiologists evaluated CT and DWI scans. Mini-mental status examinations (MMSE) were performed on the same day with DWI.
  
  
  RESULTS
  Mean age of participants was 57 ± 14 years. MMSE and DWI were performed 6 ± 3 days after surgery. New cerebral embolisms were evident in 35 of 50 patients (70%) and often occurred as multiple lesions (28/35, 80%; range 2-21). Among patients with multiple lesions, 23 (66%) were clinically silent. Pathological lesions at the origin of the arch vessels correlated with the number and volume of new DWI lesions (P < 0.05). Degree of neurocognitive dysfunction tested by MMSE was negatively associated with age (r = -0.48, P < 0.0001) and left-sided DWI lesion number and volume (r = -0.74, P < 0.0001; r = -0.707, P < 0.0001).
  
  
  CONCLUSIONS
  DWI revealed new cerebral embolisms in 70% of patients following surgery for acute type A aortic dissection. Lesion number and volume significantly correlated with pathological status of arch vessels. MMSE was representative of left-sided lesions.
authors.affiliation: Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea sevraphd@yuhs.ac.
authors.forename: Suk-Won
authors.initials: SW
authors.lastname: Song
authors.affiliation: Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Jong
authors.initials: KJ
authors.lastname: Yoo
authors.affiliation: Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Rim
authors.initials: YR
authors.lastname: Shin
authors.affiliation: Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Lim
authors.affiliation: The Korea Heart Foundation, Seoul, Republic of Korea.
authors.forename: Bum-Koo
authors.initials: BK
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000473:pathology*; D001014:Aortic Aneurysm / Q000150:complications / Q000473:pathology*; D001921:Brain / Q000098:blood supply*; D003072:Cognition Disorders / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Aortic dissection; Neurocognitive dysfunction