We examined the metabolic and hemodynamic status of patients with severe carotid stenosis and evaluated the effectiveness of carotid endarterectomy (CEA) by comparing pre- and post-operative results of quantitative proton magnetic resonance spectroscopy (^sup 1^H-MRS) and single-photon emission computed tomography (SPECT). Quantitative ^sup 1^H-MRS and SPECT were performed in 17 patients with severe carotid stenosis before CEA; in 10 patients the examinations were repeated after CEA. There was a significant correlation between the degree of internal carotid artery (ICA) stenosis and the N-acetyl-aspartate (NAA) concentration, and between CBF and NAA in the basal ganglia. In 10 of the 17 patients (58.8%) we noted a decrease of NAA on ^sup 1^H-MRS. After CEA in these patients, NAA was significantly increased, and in 7 of 8 patients whose pre-operative SPECT had indicated impairment of cerebral vasoreactivity, it was improved. Quantitative ^sup 1^H-MRS and CBF measurements can indicate the severity of metabolic and hemodynamic impairment in patients with severe carotid stenosis, and can help to assess the effectiveness of CEA. [Neurol Res 2001; 23: 573-580]
Keywords: Carotid endarterectomy; carotid stenosis; proton magnetic resonance spectroscopy; single photon emission computed tomography
INTRODUCTION
CONCLUSION
Measurement of absolute concentration of NAA and the CBF using Patlak plot method can indicate the neuronal and hemodynamic status in patients with severe carotid stenosis which could not be demonstrated by the MRI and clinical symptoms. The NAA concentration, determined by quantitative measurement, may be an indicator for evaluating the effectiveness of CEA.
REFERENCES
1 Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (ACAS): Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 1421-1428
2 North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET): Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl Med 1991; 325: 445-453
3 Duijn JH, Matson GB, Maudsley AA, Hugg JW, Weiner MW. Human brain infarction: Proton MR spectroscopy. Radiology 1992; 183: 711-718
4 Gideon P, Sperling B, Arlien-Soborg P, Olsen TS, Henriksen 0. Long-term follow-up of cerebral infarction patients with proton magnetic resonance spectroscopy. Stroke 1994; 25: 967-973
5 Graham GD, Blamire AM, Howseman AM, Rothman DL, Fayad PB, Brass LM, Petrff OAC, Shulman RG, Prichard JW. Proton magnetic resonance spectroscopy of cerebral lactate and other metabolites in stroke patients. Stroke 1992; 23: 333-340
6 Harada M, Miyoshi K, Uno M, Okada T, Hisaoka S, Hori A, Nishitani H. Neuronal impairment of adult moyamoya disease detected by quantified proton MRS and comparison with cerebral perfusion by SPECT with Tc-99m HM-PAO: A trial of clinical quantification of metabolites. J Magn Reson Imaging 1999; 10: 124-179
7 Ekholm S, Aronsson EF, Starck G, Kjellman L, Lundh T, Holm J, Volkmann R, Blomstrand C. Phosphorous-31 MR spectroscopy in the pre-operative evaluation of symptomatic unilateral carotid artery stenosis. Acta Radiologica 1996; 37: 288-293
8 Grond JG, Klijn CIM, Kappelle LJ, Eikelboom BC, Mali WPThM. Cerebral metabolism of patients with stenosis of the internal carotid artery before and after endarterectomy. J Cereb Blood Flow Metab 1996; 9: 471-477
9 Christiansen P, Stubgaard M, Gideon P, Larsson HBW. In vivo quantification of brain metabolites by 'H-MRS using water as an internal standard. Magn Reson Imaging 1993; 11: 107-118
10 Lassen NA, Anderson AR, Friberg L, Paulson OB. The retention of [^sup 99m^Tc]-d,l,-HM-PAO in the human brain after intracarotid bolus injection: A kinetic analysis. J Cereb Blood Flow Metab 1988; 8: S13-S22
11 Matsuda H, Tsuji S, Shuke N, Sumiya H, Tonami N, Hisada K. A quantitative approach to technetium-99m hexamethylpropylene amine oxime. EurJ Nucl Med 1992; 19: 195-200
12 Tallan HH. Studies on the distribution of N-acetyl-L-aspartic acid in brain. J Biol Chem 1956; 224: 41-45
13 Miller BL. A review of chemical issues in 'H-MRS spectroscopy: N-acetyl-L-aspartate, creative and choline. NMR Biomed 1991; 4: 47-52
14 Lauriero F, Federico F, Rubini G, Conte C, Simone IL, Inchingolo V, D'Addabbo A. ^sup 99^Tc^sup m^-HMPAO SPECT and ^sup 1^H-MRS (proton magnetic resonance spectroscopy) in patients with ischemic cerebral infarction. Nucl Med Commun 1996; 17: 140-146
15 Harada M, Miyoshi K, Tanouchi M, Ohtsuka H, Nishitani H. A trial for quantification of proton MR spectroscopy: Relaxation times of each metabolite and concentration using water signal as an internal standard. Nippon Acta Radiologica 1995; 55: 70-75 Opn)
16 Uno M, Ueda S, Hondo H, Matsumoto K, Harada M. Effectiveness of revascularization surgery evaluated by proton magnetic resonance spectroscopy and single photon emission computed tomography. Neurol Med Chir 1996; 36: 560-567
17 Saunders DE, Howe FA, Boogaart A, McLean MA, Griffiths JR, Brown MM. Continuing ischemic damage after acute middle cerebral artery infarction in humans demonstrated by short-echo proton spectroscopy. Stroke 1995; 26: 1007-1013
18 Kume N, Hayashida K, Iwama T, Cho I, Matsunaga N. Use of 1231IMP brain SPECT to predict outcome following STA-MCA bypass surgery: Cerebral blood flow but not vasoreactivity is a predictive parameter. Eu J Nucl Med 1998; 25: 1637-1642
19 Federico F, Simone IL, Conte C, Lucivero V, Giannini P, Liguori M, Picciola E, Tortorella C. Prognostic significance of magnetic changes detected by proton magnetic resonance spectroscopy in ischemic stroke. J Neurol 1996; 243: 241-247
20 Fenstermacher MJ, Narayana PA. Serial proton magnetic resonance spectroscopy of ischemic brain injury in humans. Invest Radiol 1990; 25: 1034-1039
Masaaki Uno, Masafumi Harada* and Shinji Nagahiro
Department of Neurological Surgery, *Department of Radiology, School of Medicine, The University of Tokushima, Tokushima, Japan
Correspondence and reprint requests to: Masaaki Uno, MD, Department of Neurological Surgery, School of Medicine, The University of Tokushima, Tokushima, Japan. [neuros@clin.med.tokushima-u.ac.jp]
Accepted for publication December 2000.
Copyright Forefront Publishing Group Sep 2001
Provided by ProQuest Information and Learning Company. All rights Reserved
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