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Evaluation of brain lesions in patients after coronary artery bypass grafting using MRI with the emphasis on susceptibility-weighted imaging.

Michałowska I, Furmanek MI, Smaga E, Juraszyński Z, Zieliński T, Chełstowska S, Kuśmierczyk M, Szpakowski E, Mierzyńska A, Walecki JM - Kardiochir Torakochirurgia Pol (2015)

Bottom Line: Hemorrhagic stroke was observed in 1 patient.In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Institute of Cardiology, Warsaw, Poland.

ABSTRACT

Introduction: Patients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders.

The aim of the study: The aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG.

Material and methods: Patients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed.

Results: Fifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.

Conclusions: The use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.

No MeSH data available.


Related in: MedlinePlus

Diffusion-weighted imaging and ADC images before (A, B) and after coronary artery bypass grafting (C, D). Postoperative scan revealed a focal lesion of diffusion restriction in the white matter of the left hemisphere (arrow)
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Figure 0002: Diffusion-weighted imaging and ADC images before (A, B) and after coronary artery bypass grafting (C, D). Postoperative scan revealed a focal lesion of diffusion restriction in the white matter of the left hemisphere (arrow)

Mentions: In the whole group of operated patients (on-pump and off-pump CABG), multiple, small lesions were observed in 5 patients, and solitary changes were present in 6 patients. Hemorrhagic stroke in the region supplied by the posterior cerebral artery was observed in 1 patient who underwent on-pump CABG. Acute ischemic lesions (visible on DWI) were detected in 4 patients (Fig. 2), in 6 patients new lesions were visible only on SWI (Fig. 3), while in 1 case lesions were visible on SWI and DWI. No correlation was observed between the age of patients (over and under 70 years), hypertension, diabetes mellitus, hypercholesterolemia, and the appearance of postoperative lesions detected by MRI. There was no significant association between the degree of preoperative cerebral lesions and presence of new cerebral lesions in the postoperative period. Characteristics of both groups of patients are presented in Table I.


Evaluation of brain lesions in patients after coronary artery bypass grafting using MRI with the emphasis on susceptibility-weighted imaging.

Michałowska I, Furmanek MI, Smaga E, Juraszyński Z, Zieliński T, Chełstowska S, Kuśmierczyk M, Szpakowski E, Mierzyńska A, Walecki JM - Kardiochir Torakochirurgia Pol (2015)

Diffusion-weighted imaging and ADC images before (A, B) and after coronary artery bypass grafting (C, D). Postoperative scan revealed a focal lesion of diffusion restriction in the white matter of the left hemisphere (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4520514&req=5

Figure 0002: Diffusion-weighted imaging and ADC images before (A, B) and after coronary artery bypass grafting (C, D). Postoperative scan revealed a focal lesion of diffusion restriction in the white matter of the left hemisphere (arrow)
Mentions: In the whole group of operated patients (on-pump and off-pump CABG), multiple, small lesions were observed in 5 patients, and solitary changes were present in 6 patients. Hemorrhagic stroke in the region supplied by the posterior cerebral artery was observed in 1 patient who underwent on-pump CABG. Acute ischemic lesions (visible on DWI) were detected in 4 patients (Fig. 2), in 6 patients new lesions were visible only on SWI (Fig. 3), while in 1 case lesions were visible on SWI and DWI. No correlation was observed between the age of patients (over and under 70 years), hypertension, diabetes mellitus, hypercholesterolemia, and the appearance of postoperative lesions detected by MRI. There was no significant association between the degree of preoperative cerebral lesions and presence of new cerebral lesions in the postoperative period. Characteristics of both groups of patients are presented in Table I.

Bottom Line: Hemorrhagic stroke was observed in 1 patient.In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Institute of Cardiology, Warsaw, Poland.

ABSTRACT

Introduction: Patients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders.

The aim of the study: The aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG.

Material and methods: Patients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed.

Results: Fifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.

Conclusions: The use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.

No MeSH data available.


Related in: MedlinePlus