ENDOVASKÜLER KOİL EMBOLİZASYONU İLE TEDAVİ EDİLEN İNTRASEREBRAL ANEVRİZMALARDA MANYETİK REZONANS PERFÜZYON DİNAMİĞİNİN DEĞERLENDİRİLMESİ Evaluation of Magnetic Resonance Perfusion Dynamics in Patıents with Intracerebral Aneurysms Treated with Endovascular Coil Embolization

OZET Giris ve Amac: Anevrizmalar kese ici doluma bagli olusan kitle etkisiyle, rupturune bagli olusan kanama ve vaskuler spazm gibi komplikasyonlarla beyin hemodinamigini ve perfuzyonunu etkiler. Bu nedenle, tedavideki amac anevrizmayi tam olarak dolasim disinda birakarak kanama ihtimalinin ortadan kaldirilmasi, kitle etkisinin yok edilmesi ve bunun yani sira ana arterdeki kan akiminin korunmasidir. Calismamizdaki amacimiz, anevrizma tedavisinin beyin perfuzyonu uzerinde yaptigi degisimlerin belirlenmesidir. Gerec ve Yontem: 2014 - 2017 tarihleri arasinda Ataturk Universite Radyoloji A.B.D.’da endovaskuler anevrizma tedavisi yapilan 42 hasta incelemeye alindi. 8 hasta degerlendirme kriterlerine uymadigi icin calismadan cikarildi. Calismada yaslari 21-69 arasinda degisen 34 hastada islem oncesi, islem sonrasi 3. gun ve islem sonrasi 1. ay beyin perfuzyon parametreleri (rCBV, rCBF, MTT ve TTP) , posterior dolasimla kiyaslanarak perfuzyon parametrelerinde ki degisimler istatistiksel olarak degerlendirildi. Bulgular: Calisma populasyonumuzun ortalama yasi 52 yastir.(21-69) Hastalarimizda anevrizma boyutu ≤10mm olculmus olup kucuk anevrizmalar sinifinda degerlendirildi. Operasyon oncesi, operasyon sonrasi ucuncu gun ve operasyon sonrasi birinci aya ait perfuzyon parametreleri karsilastirildiginda rCBV, rCBF ve MTT degerleri bakimindan operasyon oncesi ve sonrasinda istatistiksel olarak anlamli farklilik saptanmamistir. Istatistiksel p degerleri: rCBV icin p=0.652 , rCBF icin p=0.563 , MTT icin p=0.865 bulunmustur. TTP haritasindan elde edilen degerlerde ise operasyon oncesine gore, operasyon sonrasi ucuncu gun uzama ve operasyon sonrasi birinci ayda ise azalma izlenmis olup anlamli farklilik tespit edilmistir.( p=0.025 ) Sonuc: Kucuk anevrizmalar beyin perfuzyonunda rCBV ve rCBF’ye etki etmediginden bu anevrizmalarin tedavisinde perfuzyona bagli hiperperfuzyon sendromu beklenmemektedir. TTP haritasinin 3. gun uzamasi ve 1. ay kisalmasi islem sirasinda ve sonrasinda gelisen beyin odemi, vazospazm gibi komplikasyonlari acisindan gosterge olabilir. Anahtar Kelimeler: Serebral anevrizma; Perfuzyon; Manyetik rezonans ABSTRACT Introduction and purpose: Aneurysms affect the hemodynamics and perfusion of the brain, with complications such as intraparenchymal mass, ruptured bleeding, and vascular spasm. For this reason, the purpose of the treatment is to remove an aneurysm completely from the circulation, to eliminate the possibility of bleeding, to destroy the mass effect, and to protect the blood flow in the main artery. Our study aims to determine how aneurysm treatment affects brain perfusion. Materials and Methods: Between 2014 and 2017, 42 patients who underwent endovascular aneurysm treatment at Ataturk University’s Radiology Department were examined. Eight patients were excluded from the study because they did not meet the inclusion criteria. The data for 34 patients were evaluated in the study. Brain perfusion parameters were measured before the procedure, 3 days after the procedure, and 1 month after the procedure. Also, rCBV, rCBF, MTT, and TTP parameters were compared with posterior circulation, and the changes in perfusion parameters were evaluated statistically. Results: The size of the aneurysm was measured as ≤ 10 mm in our patients. Thus these patients were evaluated as part of the small aneurysm class. When the perfusion parameters were compared, there was no significant difference between preoperative and postoperative values in terms of rCBV, rCBF, and MTT. The p values obtained were as follows: p = 0.652 for rCBV, p = 0.563 for rCBF, and p = 0.865 for MTT. There was a significant difference in the values obtained from the TTP map (p = 0.025). According to the measurements taken before the operation, prolongation was observed on the third day after the operation, which decreased in the first month after the operation. Conclusion: Because small aneurysms do not affect rCBV and rCBF during brain perfusion, perfusion-related complications (hyperperfusion syndrome), which can be seen during the treatment of aneurysms, are not expected. The third-day prolongation and the shortening of the first month of the TTP period may be indicative of complications such as brain edema and vasospasm, which may develop during or after the procedure Keywords: Magnetic resonance perfusion ;Intracerebral aneurysms ;Endovascular coil embolization