Crossed cerebellar diaschisis after stroke: Can perfusion-weighted MRI show functional inactivation?

Abstract

In this study, we aimed to assess the detection of crossed cerebellar diaschisis (CCD) following stroke by perfusion-weighted magnetic resonance imaging (PW-MRI) in comparison with positron emission tomography (PET). Both PW-MRI and 15O-water-PET were performed in acute and subacute hemispheric stroke patients. The degree of CCD was defined by regions of interest placed in the cerebellar hemispheres ipsilateral (I) and contralateral (C) to the supratentorial lesion. An asymmetry index (AI = C/I) was calculated for PET-cerebral blood flow (CBF) and MRI-based maps of CBF, cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The resulting AI values were compared by Bland-Altman (BA) plots and receiver operating characteristic analysis to detect the degree and presence of CCD. A total of 26 imaging procedures were performed (median age 57 years, 20/26 imaged within 48 hours after stroke). In BA plots, all four PW-MRI maps could not reliably reflect the degree of CCD. In receiver operating characteristic analysis for detection of CCD, PW-CBF performed poorly (accuracy 0.61), whereas CBV, MTT, and TTP failed (accuracy < 0.60). On the basis of our findings, PW-MRI at 1.5 T is not suited to depict CCD after stroke.

Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

“…Moreover, we enrolled a large patient cohort which exceeded the size of study populations investigated in terms of CCD so far (mean: 51.1; range: 18-113). 13,14,17,22,25,26,28,52 Still, we cannot fully rule out the possibility of having underestimated the frequency of CCD as we counted only those cases as CCD positive, that show hemodynamic alterations suggestive of CCD in at least two perfusion parameter maps. However, artifacts on single perfusion maps can often be observed in CT imaging of the posterior fossa and this approach helped to limit the number of false-positive findings.…”

Correlation of Asymmetry Indices Measured by Arterial Spin-Labeling MR Imaging and SPECT in Patients with Crossed Cerebellar Diaschisis

“…However, another study reported that DSC MR perfusion at 1.5T was not suited to show CCD after stroke because of poor accuracy compared with that of PET. 21 Recently, arterial spin-labeling (ASL) was introduced as a noninvasive method for assessing cerebral hemodynamics. This method uses endogenous arterial water as a freely diffusible tracer labeled by radiofrequency pulses.…”

Crossed Cerebellar Diaschisis: Insights into Oxygen Challenge MRI

“…These findings are consistent with previous studies that have reported metabolic changes of CCD, which also reported hemodynamic changes. [4][5][6] However, we cannot exclude an influence of hyperoxia-induced change in CBF and CBV, on the OCI results, since hyperoxia precipitates a decrease in CBF and CBV in healthy tissue, which may reduce T2*-weighted signal intensity. However, any influence of hemodynamic changes after respiratory challenge on the T2*-weighted signal has been shown to be relatively small, if present.…”

“…3 PET is the gold standard technique used to show CCD, and few studies have used magnetic resonance (MR) imaging to show the hemodynamic changes associated with the phenomenon. [4][5][6] Madai et al 6 showed that although reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) may be seen with MR perfusion (MRP), perfusion maps did not reliably reflect the degree of CCD.…”