Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging

Abstract

Background and purposeArterial spin-labeling (ASL) was recently introduced as a noninvasive method to evaluate cerebral hemodynamics. The purposes of this study were to assess the ability of ASL imaging to detect crossed cerebellar diaschisis (CCD) in patients with their first unilateral supratentorial hyperacute stroke and to identify imaging or clinical factors significantly associated with CCD.Materials and methodsWe reviewed 204 consecutive patients who underwent MRI less than 8 hours after the onset of stroke symptoms. The inclusion criteria were supratentorial abnormality in diffusion-weighted images in the absence of a cerebellar or brain stem lesion, bilateral supratentorial infarction, subacute or chronic infarction, and MR angiography showing vertebrobasilar system disease. For qualitative analysis, asymmetric cerebellar hypoperfusion in ASL images was categorized into 3 grades. Quantitative analysis was performed to calculate the asymmetric index (AI). The patients’ demographic and clinical features and outcomes were recorded. Univariate and multivariate analyses were also performed.ResultsA total of 32 patients met the inclusion criteria, and 24 (75%) presented CCD. Univariate analyses revealed more frequent arterial occlusions, higher diffusion-weighted imaging (DWI) lesion volumes and higher initial NIHSS and mRS scores in the CCD-positive group compared with the CCD-negative group (all p < .05). The presence of arterial occlusion and the initial mRS scores were related with the AI (all p < .05). Multivariate analyses revealed that arterial occlusion and the initial mRS scores were significantly associated with CCD and AI.ConclusionASL imaging could detect CCD in 75% of patients with hyperacute infarction. We found that CCD was more prevalent in patients with arterial occlusion, larger ischemic brain volumes, and higher initial NIHSS and mRS scores. In particular, vessel occlusion and initial mRS score appeared to be significantly related with CCD pathophysiology in the hyperacute stage.

PET Imaging of Crossed Cerebellar Diaschisis after Long-Term Cerebral Ischemia in Rats

“…Previous studies have suggested that the remote deactivation of cerebellar neurons can be promoted as a result of the interruption of excitatory impulses by the corticopontocerebellar tract [4]. CCD has been reported in several diseases affecting the brain such as cerebral gliomas [5], epilepsy [6], intracerebral hemorrhage [7, 8], and stroke [3, 9–11], among others. In the latter, CCD has been detected at the acute, subacute, and chronic phases.…”

“…CCD in human supratentorial brain infarction has been detected with positron emission tomography (PET) and single photon emission computed tomography (SPECT) [13, 14, 16–19]. Alternatively to nuclear imaging techniques, arterial spin-labeling (ASL) has also proven efficient for the evaluation of CCD after hyperacute and acute ischemic stroke [9, 20]. Unexpectedly, although CCD has been detected in patients with stroke, the in vivo imaging evaluation of this phenomenon in rodent models of cerebral ischemia has been never evaluated so far.…”

BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

“…[1][2][3] The subsequent reduction in both blood flow and oxygen extraction fraction in the affected cerebellar hemisphere is traditionally detected with ( 15 O)-H 2 O-PET. 2,[4][5][6][7][8][9] Contemporary MRI techniques, such as dynamic susceptibility contrast MRI [10][11][12] and arterial spin labeling, 13,14 however, may be favored because of better clinical accessibility and absence of exogenous radioisotopes.…”

Cerebellar Stroke

“…Diaschisis is explained as a functional depression of cerebello-thalamic-cerebral pathway (Boni et al 1992). Arterial spin labeling imaging can also detect the diaschisis in 75% of patients with hyperacute infarction in the anterior circulation (Kang et al 2017). The occurrence is influenced by the degree of the anterior perfusion reduction and location rather than infarct volume (Sommer et al 2016).…”