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(Stroke. 2004;35:888.)
© 2004 American Heart Association, Inc.

Original Contributions

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 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.

Correspondence to Georg Bachmann, MD, Department of Radiology, Kerckhoff Klinik, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. 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 S100ß 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 S100ß 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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