MDCT in Imaging of Hyperperfusion Syndrome after Carotid Surgery

Abstract

Aim: to assess MDCT abilities in imaging hyperperfusion syndrome (HPS) after carotid surgery.

Materials and methods. Cases of hyperperfusion syndrome after carotid revascularization were analyzed at 595 patients underwent surgery during 2012–2016. Preoperatively complex visualization: ultrasound imaging of brachiocephalic arteries and cerebral vessels, computer tomography of the brain, computed angiography (CTA) brachiocephalic arteries and cerebral vessels, perfusion computer tomography (PCT). Computer tomography was held with Philips iCT 256 slices. During CTA 50 ml on nonionic contrast media was injected (4–4.5 ml/sec flow) with further arterial and venous phases. PCT covered 6 sm (basal ganglia and cerebral hemispheres), 35 cycles with 2 sec interval. If HPS was considered all patients underwent CT: non-contrast brain imaging, CTA and PCT (in stable patient condition). Further dynamic imaging was made at MRI 3 Tl with standard sequences (T1, T2, FLAIR, DWI).

Results. HPS was detected in 7 cases, all patients had characteristic clinical presentation. According to imaging data all patients could be divided in three groups. Diffuse hemispheric edema on the operation side – 3 cases, at follow up imaging – regression of changes. Hemorrhagic component – 2 patients, one – with small hemorrhagic focus, another – with massive intracerebral hematoma. In 2 cases there were no new cerebral lesions detected. At CTA and PCT – increase of cerebral flow after operation. Mortality in patients with HPS was 28% (2 patients). In other cases there was regress of clinical symptoms.

Conclusion. In all cases in our study the one was able to either to diagnose either to suggest HPS on the CT data. Detailed analyses of acquired data and comparison with clinical status were necessary, sometimes – follow up studies were essential.