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RT Journal Article
SR Electronic
T1 Blood-Brain Barrier Disruption after Cardiac Surgery
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 518
OP 523
DO 10.3174/ajnr.A3251
VO 34
IS 3
A1 Merino, J.G.
A1 Latour, L.L.
A1 Tso, A.
A1 Lee, K.Y.
A1 Kang, D.W.
A1 Davis, L.A.
A1 Lazar, R.M.
A1 Horvath, K.A.
A1 Corso, P.J.
A1 Warach, S.
YR 2013
UL http://www.ajnr.org/content/34/3/518.abstract
AB 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. CABGcoronary artery bypass graftingHARMhyperintense acute reperfusion markerMMP-9matrix metalloproteinase-9mRSmodified Rankin scale