Published Online
on February 19, 2004

A more recent version of this article appeared on April 1, 2004

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Submitted on December 10, 2003
Accepted on December 16, 2003

Diffusion-Weighted Magnetic Resonance Imaging and Neurobiochemical Markers After Aortic Valve Replacement. Implications for Future Neuroprotective Trials?

Erwin Stolz MD; Tibo Gerriets MD; Alexander Kluge MD; Wolf-Peter Klövekorn MD; Manfred Kaps MD; and Georg Bachmann MD^*

From the Department of Neurology, Justus Liebig University, Giessen (E.S., T.G., M.K.), and Departments of Radiology (E.S., T.G., A.K., G.B.) and Cardiac Surgery (W.-P.K.), Kerckhoff Klinik and Kerckhoff Research Foundation, Bad Nauheim, Germany.

^* To whom correspondence should be addressed. E-mail: georg.bachmann{at}kerckhoff.med.uni-giessen.de.

Background and Purpose--Cardiac surgery carries a high risk of neurological complications; therefore, these patients would be an appropriate target population for neuroprotective strategies. In this study, we evaluated postoperative diffusion-weighted imaging (DWI) as a potential surrogate marker for brain embolism and its relationship to neurobiochemical markers of brain injury.

Methods--Of a total of 45 consecutive patients undergoing aortic valve replacement, 37 completed preoperative and postoperative MRI. At the time of the MRI studies, serum S100 and neuron-specific enolase concentrations were determined. Preexisting T2 and postoperative DWI lesion volumes were quantified. All patients had a blinded neurological examination before and after operation.

Results--New perioperative DWI lesions were present in 14 patients (38%), of whom only 3 developed focal neurological deficits. Eighteen small lesions were found in the white matter or vascular border zones in all but 2 patients with territorial stroke. The appearance of new DWI lesions correlated with age, pre-existing T2 lesion volume, and postoperative S100 concentrations on days 2 to 4 after surgery. In a forward stepwise canonical discrimination model, only T2 lesion volume was selected as a relevant variable.

Conclusions--The incidence of postoperative DWI lesions in aortic valve replacement is high, and a suitable marker for neuroprotective trials would be a reduction in the number of such lesions. The volume of preexisting T2 lesions is related to the development of perioperative DWI lesions.

Key words: embolism • magnetic resonance imaging • neuron-specific enolase • stroke • S100 proteins

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