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

Koung Mi Kang,Seung Hong Choi,Sun-Won Park,Keun-Hwa Jung,Chul-Ho Sohn,Ji-Hoon Kim,Roh-Eul Yoo,Tae Jin Yun

doi:10.1371/journal.pone.0173971

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.

Highlights

Diaschisis refers to secondary neuronal depression in an area of the brain caused by loss of connections with a remote injured brain area [1]
Univariate analyses revealed more frequent arterial occlusions, higher diffusion-weighted imaging (DWI) lesion volumes and higher initial National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores in the crossed cerebellar diaschisis (CCD)-positive group compared with the CCD-negative group
The presence of arterial occlusion and the initial mRS scores were related with the asymmetric index (AI)

Summary

Introduction

Diaschisis refers to secondary neuronal depression in an area of the brain caused by loss of connections with a remote injured brain area [1]. It is necessary to identify a simple, noninvasive method to detect and intensively study CCD. Arterial spin-labeling (ASL) is becoming increasingly used as a completely noninvasive perfusion-weighted MRI technique to evaluate cerebral hemodynamics. Because ASL uses endogenous arterial water as a freely diffusible tracer (instead of exogenous radioisotopes), it represents a noninvasive alternative to SPECT and PET for studying CCD [18,19]. Arterial 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

Methods

Results

Conclusion