Evaluation of brain lesions in patients after coronary artery bypass grafting using MRI with the emphasis on susceptibility-weighted imaging.
BACKGROUND
Patients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders.


OBJECTIVE
The aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG.


METHODS
Patients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed.


RESULTS
Fifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.


CONCLUSIONS
The use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.
Department of Radiology, Institute of Cardiology, Warsaw, Poland.
Ilona
I
Michałowska
Radiology and Diagnostic Imaging, Medical Centre of Postgraduate Education, Warsaw, Poland.
Mariusz Ireneusz
MI
Furmanek
Independent Clinic of Neurology and Clinical Neurophysiology, Institute of Cardiology, Warsaw, Poland.
Elżbieta
E
Smaga
Allenort Hospital, Warsaw, Poland.
Zbigniew
Z
Juraszyński
Department of Heart Failure and Transplantation, Institute of Cardiology, Warsaw, Poland.
Tomasz
T
Zieliński
Department of Diagnostic Imaging, Center for Children's Health, Warszawa, Poland.
Sylwia
S
Chełstowska
Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
Mariusz
M
Kuśmierczyk
Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
Eugeniusz
E
Szpakowski
Department of Heart Failure and Transplantation, Institute of Cardiology, Warsaw, Poland.
Anna
A
Mierzyńska
Medical Centre of Postgraduate Education, Warsaw, Poland.
Jerzy Michał
JM
Walecki
CABG; MR; brain changes