Temporal changes and implications of diffusion tensor imaging metrics and cerebral white matter volume in patients undergoing carotid endarterectomy - a prospective study.

IF 2.4 3区医学 Q2 CLINICAL NEUROLOGY Neuroradiology Pub Date : 2025-01-17 DOI:10.1007/s00234-024-03527-4

Andrea Varga, Csongor Péter, Milán Vecsey-Nagy, Gyula Gyebnár, Sarolta Borzsák, Bálint Szilveszter, Zsuzsanna Mihály, Zsófia Czinege, Péter Sótonyi

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Abstract

Aims: To test utility of diffusion MRI-derived indices in carotid endarterectomy (CEA), change of diffusion tensor imaging (DTI) metrics, cerebral white matter (WM) volumes were evaluated and predictors of overall mortality determined.

Methods: Prospectively enrolled participants had preoperative, immediate and late postoperative DTI after CEA. WM volumes, DTI metrics (fractional anisotropy, FA; axial, radial, mean diffusivities; AD, RD, MD, respectively) were calculated for the index/contralateral hemispheres at all time points. Temporal changes, predictors of log₂-transformed WM volumes, DTI values were analyzed using linear mixed model. Uni- and multivariable Cox proportional hazards models were used to identify predictors of mortality.

Results: 60 subjects (57% male, 69.5 ± 7.2years) were included. Significantly increased AD and MD was observed in both hemispheres comparing the preoperative and immediate postoperative DTI metrics (index AD: β = 0.02 [95%CI:0.01,0.02], p < 0.001; index MD: β = 0.02 [95%CI:0.01,0.03], p < 0.001; contralateral AD: β = 0.01 [95%CI:0.01,0.02], p = 0.001; contralateral MD: β = 0.02 [95%CI:0.01,0.03], p = 0.003). The index MD decreased (β = 0.01 [95%CI:0.01,0.001], p = 0.04), bilateral WM volumes (index WM: β = 0.04 [95%CI:0.02,0.07], p < 0.001; contralateral WM: β = 0.05 [95%CI:0.03,0.07], p < 0.001) decreased significantly between the immediate and late postoperative scans. Postoperative contralateral FA correlated significantly with lower mortality (HR = 0.001 [95%CI:0.001,0.19], p = 0.02); postoperative contralateral RD (HR = 3.74 × 10⁴ [95%CI:1.62,8.60 × 10⁸], p = 0.04) and MD (HR = 1.19 × 10⁵ [95%CI:1.03,1.37 × 10¹⁰], p = 0.049) were significant predictors of mortality.

Conclusion: The increase of various DTI metrics from pre-to-postoperative may be indicative of microstructural deterioration following CEA. Temporal changes between the immediate and late postoperative scans suggest, however, reversal of detrimental WM changes and clearance of presumed subclinical WM edema. Our results also imply, that preserved cerebral properties are protective after CEA.

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颈动脉内膜切除术患者弥散张量成像指标和脑白质体积的时间变化及其意义——一项前瞻性研究。

目的：为了检验弥散mri衍生指标在颈动脉内膜切除术（CEA）中的效用，评估弥散张量成像（DTI）指标的变化、脑白质（WM）体积，并确定总死亡率的预测因子。方法：前瞻性入选的参与者在CEA术后进行术前、即刻和术后晚期的DTI。WM体积，DTI指标(分数各向异性，FA；轴向、径向、平均扩散系数；在所有时间点计算指数/对侧半球的AD， RD， MD。采用线性混合模型分析时间变化、log2变换后WM体积的预测因子、DTI值。使用单变量和多变量Cox比例风险模型来确定死亡率的预测因子。结果：纳入60例，男性57%，年龄69.5±7.2岁。术前和术后即刻DTI指标（AD指数：β = 0.02 [95%CI:0.01,0.02], p 4 [95%CI:1.62,8.60 × 108], p = 0.04）和MD （HR = 1.19 × 105 [95%CI:1.03,1.37 × 1010], p = 0.049）是死亡率的显著预测因子。结论：从术前到术后，各种DTI指标的增加可能表明CEA后微结构恶化。然而，术后即时和后期扫描之间的时间变化表明，有害的WM变化逆转，并清除了推定的亚临床WM水肿。我们的研究结果还表明，CEA后保存的脑特性具有保护作用。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.