Prediction of cerebral hyperperfusion following carotid endarterectomy using intravoxel incoherent motion magnetic resonance imaging

Tatsuhiko Takahashi; Ikuko Uwano; Yosuke Akamatsu; Kohei Chida; Masakazu Kobayashi; Kenji Yoshida; Shunrou Fujiwara; Yoshitaka Kubo; Makoto Sasaki; Kuniaki Ogasawara

doi:10.1016/j.jstrokecerebrovasdis.2022.106909

Prediction of cerebral hyperperfusion following carotid endarterectomy using intravoxel incoherent motion magnetic resonance imaging

J Stroke Cerebrovasc Dis. 2023 Feb;32(2):106909. doi: 10.1016/j.jstrokecerebrovasdis.2022.106909. Epub 2022 Nov 25.

Authors

Affiliations

¹ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: ttatsu@iwate-med.ac.jp.
² Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: uwano@iwate-med.ac.jp.
³ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: akamatsu@iwate-med.ac.jp.
⁴ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: kchida@iwate-med.ac.jp.
⁵ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: kobamasa@iwate-med.ac.jp.
⁶ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: kenyoshi@iwate-med.ac.jp.
⁷ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: shunfuji@iwate-med.ac.jp.
⁸ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: yokubo@iwate-med.ac.jp.
⁹ Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: masasaki@iwate-med.ac.jp.
¹⁰ Department of Neurosurgery, Iwate Medical University, Iwate, Japan; Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan. Electronic address: kuogasa@iwate-med.ac.jp.

PMID: 36442280
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106909

Abstract

Objectives: One of the risk factors for cerebral hyperperfusion following carotid endarterectomy (CEA) is a chronic reduction in cerebral perfusion pressure due to internal carotid artery (ICA) stenosis, which is clinically detected as increased cerebral blood volume (CBV). The perfusion fraction (f) is one of the intra-voxel incoherent motion (IVIM) parameters obtained using magnetic resonance (MR) imaging that theoretically reflects CBV. The present study aimed to determine whether preoperative IVIM-f on MR imaging predicts development of cerebral hyperperfusion following CEA.

Materials and methods: Sixty-eight patients with unilateral ICA stenosis (≥ 70%) underwent preoperative diffusion-weighted 3-T MR imaging, and IVIM-f maps were generated from these data. Quantitative brain perfusion single-photon emission computed tomography (SPECT) was performed before and immediately after CEA. Regions-of-interest (ROIs) were automatically placed in the bilateral middle cerebral artery territories in all images using a three-dimensional stereotactic ROI template, and affected-to-contralateral ratios in the ROIs were calculated on IVIM-f maps.

Results: Nine patients (13%) exhibited postoperative hyperperfusion (cerebral blood flow increases of ≥ 100% compared with preoperative values in the ROIs on brain perfusion SPECT). Only high IVIM-f ratios were significantly associated with the occurrence of postoperative hyperperfusion (95% confidence interval, 253.8-6774.2; p = 0.0031) on logistic regression analysis. The sensitivity, specificity, and positive and negative predictive values of the IVIM-f ratio to predict the occurrence of postoperative hyperperfusion were 100%, 81%, 45%, and 100%, respectively.

Conclusions: Preoperative IVIM-f on MR imaging can predict development of cerebral hyperperfusion following CEA.

Keywords: Carotid endarterectomy; Cerebral hyperperfusion; Intravoxel incoherent motion; Magnetic resonance imaging.

MeSH terms

Carotid Stenosis* / diagnostic imaging
Carotid Stenosis* / etiology
Carotid Stenosis* / surgery
Cerebrovascular Circulation / physiology
Constriction, Pathologic / etiology
Endarterectomy, Carotid* / adverse effects
Humans
Magnetic Resonance Imaging
Tomography, Emission-Computed, Single-Photon