Blood-Brain Barrier Disruption after Cardiac Surgery

被引：79

作者：

Merino, J. G. ^{[1
,2
]}

Latour, L. L. ^{[1
]}

Tso, A. ^{[3
]}

Lee, K. Y. ^{[4
]}

Kang, D. W. ^{[5
]}

Davis, L. A. ^{[1
]}

Lazar, R. M. ^{[6
]}

Horvath, K. A. ^{[2
,7
]}

Corso, P. J. ^{[8
]}

Warach, S. ^{[1
]}

机构：

[1] NINDS, Sect Stroke Diagnost & Therapeut, Bethesda, MD 20892 USA

[2] Johns Hopkins Community Phys, Bethesda, MD USA

[3] Univ Calif San Francisco, Dept Neurol, San Francisco, CA USA

[4] Yonsei Univ, Coll Med, Dept Neurol, Seoul, South Korea

[5] Asan Med Ctr, Seoul, South Korea

[6] Columbia Univ, Dept Neurol, Coll Phys & Surg, New York, NY USA

[7] NHLBI, Bethesda, MD 20892 USA

[8] Washington Hosp Ctr, Dept Cardiac Surg, Washington, DC 20010 USA

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2013年 / 34卷 / 03期

基金：

美国国家卫生研究院;

关键词：

CARDIOPULMONARY BYPASS; MATRIX METALLOPROTEINASES; REPERFUSION INJURY; ACUTE STROKE; MR-IMAGES; OFF-PUMP; RECOVERY; PERMEABILITY; LESIONS; FLAIR;

D O I：

10.3174/ajnr.A3251

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

To shed light on brain complications occurring after heart surgery, the authors assessed BBB disruption and DWI findings in half of their patients by imaging at 24 hours after surgery and 24-48 hours later. Additionally, postcontrast T1 images were obtained postoperatively at 2-4 days in the other half of the patients. Almost half the patients undergoing cardiac surgery had evidence of BBB abnormalities and three-quarters showed acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MR can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery. BACKGROUND AND PURPOSE: CNS complications are often seen after heart surgery, and postsurgical disruption of the BBB may play an etiologic role. The objective of this study was to determine the prevalence of MR imaging-detected BBB disruption (HARM) and DWI lesions after cardiac surgery. MATERIALS AND METHODS: All patients had an MRI after cardiac surgery. For half the patients (group 1), we administered gadolinium 24 hours after surgery and obtained high-resolution DWI and FLAIR images 24-48 hours later. We administered gadolinium to the other half (group 2) at the time of the postoperative scan, 2-4 days after surgery. Two stroke neurologists evaluated the images. RESULTS: Of the 19 patients we studied, none had clinical evidence of a stroke or delirium at the time of the gadolinium administration or the scan, but 9 patients (47%) had HARM (67% in group 1; 30% in group 2; P = .18) and 14 patients (74%) had DWI lesions (70% in group 1; 78% in group 2; P = 1.0). Not all patients with DWI lesions had HARM, and not all patients with HARM had DWI lesions (P = .56). CONCLUSIONS: Almost half the patients undergoing cardiac surgery have evidence of HARM, and three-quarters have acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MR imaging can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery.

引用

页码：518 / 523

页数：6