Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy

Objectives: To determine whether pre-operative cerebral small vessel disease is associated with cerebral hyperperfusion (CH) after carotid endarterectomy (CEA).Methods: Seventy-seven patients (mean age of 66 years and 58% male) undergoing CEA for carotid stenosis were investigated using brain MRI be...

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Autores principales:	Xiaoyuan Fan, Zhichao Lai, Tianye Lin, Hui You, Juan Wei, Mingli Li, Changwei Liu, Feng Feng
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	cerebral small vessel disease carotid stenosis carotid endarterectomy hyperperfusion syndrome magnetic resonance imaging Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/df7c7a707d604c09a99b4a1c0bc03c43
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spelling	oai:doaj.org-article:df7c7a707d604c09a99b4a1c0bc03c432021-11-18T05:48:10ZPre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy2297-055X10.3389/fcvm.2021.734392https://doaj.org/article/df7c7a707d604c09a99b4a1c0bc03c432021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.734392/fullhttps://doaj.org/toc/2297-055XObjectives: To determine whether pre-operative cerebral small vessel disease is associated with cerebral hyperperfusion (CH) after carotid endarterectomy (CEA).Methods: Seventy-seven patients (mean age of 66 years and 58% male) undergoing CEA for carotid stenosis were investigated using brain MRI before and after surgery. CH was defined as an increase in cerebral blood flow > 100% compared with pre-operative values on arterial spin labeling MR images. The grade or the number of four cerebral small vessel disease markers (white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds) were evaluated based on pre-operative MRI. Cerebral small vessel disease markers were correlated with CH by using multivariate logistic regression analysis. The cutoff values of cerebral small vessel disease markers for predicting CH were assessed by receiver-operating characteristic curve analysis.Results: CH after CEA was observed in 16 patients (20.78%). Logistic regression analysis revealed that white matter hyperintensities (OR 3.09, 95% CI 1.72–5.54; p < 0.001) and lacunes (OR 1.37, 95% CI 1.06–1.76; p = 0.014) were independently associated with post-operative CH. Receiver-operating characteristic curve analysis showed that Fazekas score of white matter hyperintensities ≥3 points [area under the curve (AUC) = 0.84, sensitivity = 81.3%, specificity = 73.8%, positive predictive value (PPV) = 44.8% and negative predictive value (NPV) = 93.8%] and number of lacunes ≥ 2 (AUC = 0.73, sensitivity = 68.8%, specificity = 78.7%, PPV = 45.8% and NPV = 90.6%) were the optimal cutoff values for predicting CH.Conclusion: In patients with carotid stenosis, white matter hyperintensities and lacunes adversely affect CH after CEA. Based on the NPVs, pre-operative MR imaging can help identify patients who are not at risk of CH.Xiaoyuan FanZhichao LaiTianye LinHui YouJuan WeiMingli LiChangwei LiuFeng FengFeng FengFrontiers Media S.A.articlecerebral small vessel diseasecarotid stenosiscarotid endarterectomyhyperperfusion syndromemagnetic resonance imagingDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cerebral small vessel disease carotid stenosis carotid endarterectomy hyperperfusion syndrome magnetic resonance imaging Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	cerebral small vessel disease carotid stenosis carotid endarterectomy hyperperfusion syndrome magnetic resonance imaging Diseases of the circulatory (Cardiovascular) system RC666-701 Xiaoyuan Fan Zhichao Lai Tianye Lin Hui You Juan Wei Mingli Li Changwei Liu Feng Feng Feng Feng Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy
description	Objectives: To determine whether pre-operative cerebral small vessel disease is associated with cerebral hyperperfusion (CH) after carotid endarterectomy (CEA).Methods: Seventy-seven patients (mean age of 66 years and 58% male) undergoing CEA for carotid stenosis were investigated using brain MRI before and after surgery. CH was defined as an increase in cerebral blood flow > 100% compared with pre-operative values on arterial spin labeling MR images. The grade or the number of four cerebral small vessel disease markers (white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds) were evaluated based on pre-operative MRI. Cerebral small vessel disease markers were correlated with CH by using multivariate logistic regression analysis. The cutoff values of cerebral small vessel disease markers for predicting CH were assessed by receiver-operating characteristic curve analysis.Results: CH after CEA was observed in 16 patients (20.78%). Logistic regression analysis revealed that white matter hyperintensities (OR 3.09, 95% CI 1.72–5.54; p < 0.001) and lacunes (OR 1.37, 95% CI 1.06–1.76; p = 0.014) were independently associated with post-operative CH. Receiver-operating characteristic curve analysis showed that Fazekas score of white matter hyperintensities ≥3 points [area under the curve (AUC) = 0.84, sensitivity = 81.3%, specificity = 73.8%, positive predictive value (PPV) = 44.8% and negative predictive value (NPV) = 93.8%] and number of lacunes ≥ 2 (AUC = 0.73, sensitivity = 68.8%, specificity = 78.7%, PPV = 45.8% and NPV = 90.6%) were the optimal cutoff values for predicting CH.Conclusion: In patients with carotid stenosis, white matter hyperintensities and lacunes adversely affect CH after CEA. Based on the NPVs, pre-operative MR imaging can help identify patients who are not at risk of CH.
format	article
author	Xiaoyuan Fan Zhichao Lai Tianye Lin Hui You Juan Wei Mingli Li Changwei Liu Feng Feng Feng Feng
author_facet	Xiaoyuan Fan Zhichao Lai Tianye Lin Hui You Juan Wei Mingli Li Changwei Liu Feng Feng Feng Feng
author_sort	Xiaoyuan Fan
title	Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy
title_short	Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy
title_full	Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy
title_fullStr	Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy
title_full_unstemmed	Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy
title_sort	pre-operative cerebral small vessel disease on mr imaging is associated with cerebral hyperperfusion after carotid endarterectomy
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/df7c7a707d604c09a99b4a1c0bc03c43
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Pre-operative Cerebral Small Vessel Disease on MR Imaging Is Associated With Cerebral Hyperperfusion After Carotid Endarterectomy

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