Crossed cerebellar diaschisis in post-treatment glioma patients: A comparative study of arterial spin labelling and dynamic susceptibility contrast

Abstract

ObjectivesTo assess crossed cerebellar diaschisis (CCD) in post-treatment glioma patients, and to compare the performance of arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC) in detecting CCD. Methods and materialsThis retrospective study included 130 patients who had both DSC and ASL. Among them, 16 had underwent fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). We investigated the relationship between CCD and the location and size of supratentorial lesions, and compared PET diagnostic performance with that of ASL and DSC. We assessed the inter-methods agreement for ASL and DSC, and performed quantitative analysis by calculating the asymmetry index (AI) between bilateral cerebellum and exploring how the AI values for ASL-CBF, DSC-rCBF, and DSC-rCBV maps correlated with each other. ResultSupratentorial lesions affecting the corona radiata (P < 0.001), basal ganglia (P < 0.001), and insula (P = 0.046) were significantly associated with the occurrence of CCD. Lesion size was significantly larger (P = 0.005) in the CCD positive group. With PET as a reference, ASL-CBF and DSC-rCBF maps exhibited the best diagnostic performance compared with the other DSC-generated maps (diagnostic accuracy = 83.3% for both, area under curve (AUC) of ASL = 0.967, AUC of rCBF = 0.983), although differences were not statistically significant. The κ value for the inter-methods (ASL and DSC) agreement in detecting CCD was 0.893, while the degree of perfusion asymmetry was more significant in ASL- than DSC-generated maps. Bland-Altman plots showed that the AI for ASL-CBF was moderately correlated with those for DSC-rCBF and DSC-rCBV. ConclusionsCCD can present in post-treatment glioma patients and is detectable on MR-perfusion images including ASL-CBF, DSC-rCBF, and DSC-rCBV maps.