Article
Prediction of infarcted tissue by intraoperative Laser Speckle Imaging in patients undergoing decompressive craniectomy after malignant hemispheric stroke
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Authors
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Nils Hecht
- Neurochirurgische Klinik und Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin
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Marc-Michael Müller
- Neurochirurgische Klinik und Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin
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Nora Sandow
- Neurochirurgische Klinik und Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin
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Alexandra Pinczolits
- Neurochirurgische Klinik und Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin
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Peter Vajkoczy
- Neurochirurgische Klinik und Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin
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Johannes Woitzik
- Neurochirurgische Klinik und Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin
| Published: | May 21, 2013 |
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Outline
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Objective: Current intraoperative monitoring techniques lack adequate surveillance of cerebral blood flow (CBF). Laser Speckle Imaging (LSI) can be used for non-invasive and direct assessment of cortical perfusion. The purpose of this study was to establish precision rates (positive and negative predictive values) for LSI-specific perfusion thresholds of infarcted and non-infarcted tissue in the human brain.
Method: Intraoperative LSI was performed in 22 hemispheres of 22 patients undergoing decompressive craniectomy (DC) for treatment of malignant hemispheric stroke (MHS). Infarct size and configuration was assessed by magnetic resonance imaging (MRI) and a 3-dimensional model reconstruction of the cortical surface (defined by MP RAGE) including the infracted cortical tissue (defined by DWI/ADC) was performed. Next, a color-coded laser speckle blood flow image was superimposed onto the MRI reconstruction and the infracted and non-infarcted areas were traced onto the laser speckle image. Regions of interest (ROIs) were positioned over the laser speckle image and LSI-specific relative cortical perfusion was calculated within the ROIs of the infarcted and non-infarcted area. LSI-specific perfusion values (CBF-Flux) were normalized to 100% and relative frequency distributions of the cortical perfusion within the infracted and non-infarcted area were calculated for each patient. Finally, cumulative probability curves were computed and positive (at least 95% chance of infarct) and negative (at least 95% chance of non-infarct) prediction limits for eventual infarction were determined.
Results: In all 22 patients, LSI permitted immediate real-time visualization and measurement of relative CBF in excellent image quality and high spatial-temporal resolution. Positive and negative prediction limits of infracted tissue were determined at 40% and 110% of baseline perfusion, respectively. Of the exposed cortical surface area, 61.7±24% was determined as infracted (below the 40% limit) compared to 11.2±9% as non-infarcted (above the 110% limit) and 27.2±16% as tissue with perfusion between 40% and 110%.
Conclusions: LSI appears to be a valuable tool to sensitively predict infarcted and non-infarcted tissue in excellent spatial resolution during neurosurgical procedures.
