Postoperative increase in cerebral white matter fractional anisotropy on diffusion tensor magnetic resonance imaging is associated with cognitive improvement after uncomplicated carotid endarterectomy: tract-based spatial statistics analysis

Neurosurgery. 2013 Oct;73(4):592-8; discussion 598-9. doi: 10.1227/NEU.0000000000000013.

Abstract

Background: Carotid endarterectomy (CEA) might improve cognitive function. Fractional anisotropy (FA) values in the cerebral white matter derived from diffusion tensor magnetic resonance imaging (DTI) correlate with cognitive function in patients with various central nervous system diseases.

Objective: To use tract-based spatial statistics to determine whether postoperative changes of FA values in the cerebral white matter derived from DTI are associated with cognitive improvement after uncomplicated CEA.

Methods: In 80 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≥70%), FA values in the cerebral white matter were derived from DTI before and 1 month after surgery and were analyzed by using tract-based spatial statistics. Neuropsychological testing, consisting of the Wechsler Adult Intelligence Scale Revised, the Wechsler Memory Scale and the Rey-Osterreith Complex Figure test, was also performed preoperatively and after the first postoperative month.

Results: Based on the neuropsychological assessments, 11 (14%) patients were defined as having postoperatively improved cognition. The difference between the 2 mean FA values (postoperative values minus preoperative values) in the cerebral hemisphere ipsilateral to surgery was significantly associated with postoperative cognitive improvement (95% confidence intervals, 2.632-9.877; P = .008). White matter FA values in patients with postoperative cognitive improvement were significantly increased after surgery in the whole ipsilateral cerebral hemisphere, in the contralateral anterior cerebral artery territory, and in the watershed zone between the contralateral anterior and middle cerebral arteries.

Conclusion: Postoperative increase in cerebral white matter FA on DTI is associated with cognitive improvement after uncomplicated CEA.

MeSH terms

  • Aged
  • Anisotropy
  • Brain / pathology*
  • Brain / surgery
  • Carotid Stenosis / complications
  • Carotid Stenosis / surgery*
  • Cognition Disorders / etiology
  • Cognition Disorders / surgery*
  • Diffusion Magnetic Resonance Imaging
  • Diffusion Tensor Imaging
  • Endarterectomy, Carotid
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted
  • Male
  • Middle Aged
  • Nerve Fibers, Myelinated / pathology*
  • Neuropsychological Tests