Perioperative functional imaging after extracranial carotid endarterectomy for the detection of cerebral hyperperfusion syndrome.

INTRODUCTION: SyngoDynaPBVNeuro® is a tool to perform cerebral blood volume (CBV) measurements intraoperatively by functional imaging producing CT-like images. Aim of this prospective study was to analyze the clinical relevance and benefit of CBV measurement with regard to neurological complications like cerebral hyperfusion syndrome (CHS). METHODS: Forty-five patients undergoing endarterectomy (CEA) of the internal carotid artery were included; functional imaging with CBV measurement was performed before and after CEA. To evaluate and analyze CBV, six regions of interest (ROI) were identified for all patients with an additional ROI in patients with symptomatic ICA stenosis and previous stroke. The primary endpoint of the study was a perioperative change in CBV measurements. Secondary outcomes were incidence of stroke, TIA, CHS, and perioperative morbidity and mortality. RESULTS: Thirty-day stroke incidence and thirty-day mortality were 0%. Thirty-day morbidity was 6.7%. Two patients from the asymptomatic group suffered from transient neurological symptoms without signs of intracerebral infarction in CT or MR scan, meeting diagnostic criteria for CHS. In 83.3% of ROIs in these patients, an increase of blood volume was detected. Overall, 26.7% patients suffered from unilateral headache as expression of potential CHS. A total of 69.4% of ROIs in patients with postoperative unilateral headache showed an increase when comparing pre- and postoperative CBV measurements. CONCLUSION: The results show that increased CBV measured by functional imaging is a possible surrogate marker of neurological complications like CHS after CEA. By using intraoperative CBV measurement, the risk of CHS can be estimated early and appropriate therapeutic measures can be applied.

[SYSTEMIC INFLAMMATION MARKERS AND MICROALBUMINURIA IN INFLAMMATORY BOWEL DISEASES].

PURPOSE: The aim of the investigation was to study the characteristics of endothelial function in patients with IBD. MATERIALS AND METHODS: 61 patients with ulcerative colitis (UC) and Crohn's disease (CD) in the acute phase or with newly diagnosed forms of the disease were examined. CD group included 16 people (8 women and 8 men) mean age 35.63 ± 5.51 years. UC group included 45 patients (18 women and 27 men), their average age was 36.76 ± 3.17 years. To assess the endothelial dysfunction the level of microalbuminuria (MAU) was examined with Micral-Test strips. Serum concentration levels of CRP, TNF--α, alpha1 and alpha 2-globulins, fibrinogen as well as ESR were evaluated as the markers of systemic inflammation. RESULTS: In CD patients a significant increase of MAU in severe forms of the disease 32 ± 10.95 mg/I (p < 0.05). was revealed. Furthermore, MAU was significantly higher in individuals with extraintestinal manifestations and complications of CD (28.01 ± 17.89 mg/I and 20.00 ± 14.14 mg/, respectively). A significant relationship of the MAU levels and severity of CD (r = 0.797, p = 0.0002) as well as the presence of extraintestinal symptoms (r = 0.625, p = 0.0096) were identified. The evaluation of the systemic inflammation narkers showed a significant increase of CRP levels and ESR in severe forms of IBD. A positive correlation of CD with the ESR (r = 0.802, p = 0.0021), CRP (r = 0.773, p = 0.0004), alpha-2 globulin (r = 0.534, p = 0.0298) and fibrinogen (r = 0.647, p = 0.0067) was identified. CONCLUSIONS: The evidence of endothelial dysfunction in patients with IBD was revealed that was expressed in the MAU levels elevation. The MAU level can be regarded as the criterion of the CD severity as well as the sign of its unfavorable course.

Targeted ED-B fibronectin SPECT in vivo imaging in experimental atherosclerosis.

AIM: The extracellular matrix protein ED-B fibronectin (ED-B) is upregulated in inflammatory atherosclerotic lesions. However, functional in vivo imaging of ED-B-containing plaques has not been explored. This study evaluated whether [(99m)Tc]-conjugated AP39 ([(99m)Tc]-AP39), a single-chain antibody specific to ED-B, can be used for in vivo detection of atherosclerotic plaques in Western diet (WD)-fed, apolipoprotein E-deficient (apoE-/-) mice as compared to wildtype (WT) control mice. METHODS: Using SPECT, 12-month-old WD-fed apoE-/- and WT mice were studied 4 hours after injecting [(99m)Tc]-AP39 (148 MBq). Subsequently, mice were sacrificed, thoracic aortas measured in a g-counter, and plaques analyzed using histology, immuno-histochemistry, autoradiography, and morphometry. RESULTS: In vivo [(99m)Tc]-AP39-SPECT imaging of apoE-/- mice demonstrated a significant signal activity in the plaque-ridden thoracic aorta (52.236 ± 40.646 cpm/cm³) that co-localized with the aortic arch and the supra-aortic arteries in MRI scans. Low signal activity (9.468 ± 4.976 cpm/cm³) was observed in WT mice. In apoE-/- mice, the strongest signals were detected in the aortic root, aortic arch and along the abdominal aorta. Autoradiography analysis of aortas from apoE-/- mice confirmed the in vivo observation by demonstrating signal localization in atherosclerotic plaques. The size of autoradiography-positive plaque areas correlated significantly with the size of ED-B-positive (r=0.645, P=0.044) or macrophage-infiltrated (r=0.84, P<0.002) plaques. A significant correlation was found between the sizes of ED-B-positive and macrophage-infiltrated plaque areas (r=0.93, P<0.01). CONCLUSION: [(99m)Tc]-AP39-SPECT in vivo imaging detects inflammatory plaque lesions in WD-fed apoE-/- mice.