NEUROLOGY 1993;43:775
© 1993 American Academy of Neurology
Brain magnetic resonance imaging in coronary artery bypass grafts
A pre- and postoperative assessment
R. Schmidt, MD,
F. Fazekas, MD,
H. Offenbacher, MD,
H. Mächler, MD,
W. Freidl, PhD,
F. Payer, MD,
B. Rigler, MD,
M.I.G. Harrison, MD and
H. Lechner, MD
Departments of Neurology (Drs. Schmidt, Fazekas, Offenbacher, Freidl, Payer, and Lechner) and Cardiac Surgery (Drs. Mächler and Rigler), Karl-Franzens University Graz, Austria; and the Department of Neurology (Dr. Harrison), Middlesex Hospital, London, UK.
We undertook a study to determine (1) the frequency and prognostic significance of preexisting MRI brain abnormalities in patients undergoing coronary artery bypass grafts (CABG) and (2) whether MRI can detect surgery-related brain damage in 31 neurologically asymptomatic CABG patients (mean age, 61.0 ± 6.6 years). MRIs were performed within 7 days before and 8 to 17 days after surgery. When we compared the preoperative images with those of 31 age- and risk factor-matched neurologically asymptomatic controls free of cardiac disease (mean age, 60.3 ± 6.1 years), higher rates of thromboembolic infarcts (16% versus 0%), lacunes (58.1% versus 32.3%), and brainstem lesions (22.6% versus 3.8%) were noted. Subjective rating demonstrated significantly larger ventricles in patients than in controls (p = 0.002). CABG candidates also had significantly increased ventricular-to-intracranial cavity ratios (VICR) as determined by semiquantitative volumetric measurements (6.9 ± 2.5% versus 4.9 ± 1.6%; p = 0.0004). Eleven patients had postsurgical complications, with eight having symptoms consistent with diffuse encephalopathy. The only MRI finding that separated encephalopathic from complication-free patients was ventricular size (VICR 9.0 ± 2.5% versus 4.9 ± 1.6%; p = 0.006). This difference remained statistically significant after adjustment for the effects of age (p = 0.04). Postoperative MRI consistently failed to demonstrate surgery-related brain damage responsible for the encephalopathy.
Address correspondence and reprint requests to Dr. Reinhold Schmidt, Department of Neurology, Karl-Franzens University Graz, Auenbruggerplatz 23, A-8036 Graz, Austria.
Support for the investigation of controls was given by the "Jubilaeumsfond" of the Austrian National Bank-Project #3905.
Received June 3, 1992. Accepted for publication in final form August 14, 1992.
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