Crossed Cerebellar Diaschisis in Acute Stroke Detected by Dynamic Susceptibility Contrast MR Perfusion Imaging

• Published in: American journal of neuroradiology : AJNR Vol. 30; no. 4; pp. 710 - 715
• Main Authors: Lin, D.D.M, Kleinman, J.T, Wityk, R.J, Gottesman, R.F, Hillis, A.E, Lee, A.W, Barker, P.B
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.04.2009; American Society of Neuroradiology
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain; Cerebellar Diseases - etiology; Cerebellar Diseases - pathology; Cerebellum - blood supply; Cerebellum - pathology; Cerebrovascular Circulation; Fundamental and applied biological sciences. Psychology; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Angiography; Magnetic Resonance Imaging - methods; Medical sciences; Middle Aged; Nervous system; Perception; Prognosis; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Stroke - complications; Stroke - pathology; Vision; Young Adult; Cerebellum; Stroke; Nervous system diseases; Radiodiagnosis; Central nervous system; Cardiovascular disease; Nuclear magnetic resonance imaging; Encephalon; Cerebral disorder; Vascular disease; Perfusion imaging; Central nervous system disease; Diaschisis; Cerebrovascular disease
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1435

Crossed cerebellar diaschisis (CCD), the decrease in blood flow and metabolism in the cerebellar hemisphere contralateral to a supratentorial stroke, is frequently reported on positron-emission tomography (PET) and single-photon emission CT (SPECT) but is rarely described with MR perfusion techniques. This study was undertaken to determine the frequency of CCD observed in acute stroke by retrospective review of a research data base of patients with acute stroke evaluated by diffusion-weighted (DWI) and dynamic contrast susceptibility perfusion MR imaging (PWI). PWI scans of 301 consecutive patients with acute stroke and positive DWI abnormality from a research data base were reviewed. Contralateral cerebellar hypoperfusion was identified by inspection of time-to-peak (TTP) maps for asymmetry with an absence of cerebellar abnormalities on T2-weighted scans, DWI, or disease of the vertebrobasilar system on MR angiography. In a subset of the cases, quantitative analysis of perfusion scans was performed using an arterial input function and singular value decomposition (SVD) to generate cerebral blood flow (CBF) maps. A total of 47 of 301 cases (15.61%) met the criteria of CCD by asymmetry of cerebellar perfusion on TTP maps. On quantitative analysis, there was corresponding reduction of CBF by 22.75 +/- 10.94% (range, 7.45% to 52.13%) of the unaffected cerebellar hemisphere). MR perfusion techniques can be used to detect CCD, though the frequency presented in this series is lower than that commonly reported in the PET/SPECT literature. Nevertheless, with its role in acute stroke and noninvasive nature, MR perfusion may be a viable alternative to PET or SPECT to study the phenomenon and clinical consequences of supratentorial stroke with CCD.