Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging.
Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging.
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DOI：
10.3174/ajnr.a1435
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发表时间：
2009-04
期刊：
影响因子：
--
通讯作者：
Barker PB
中科院分区：
文献类型：
--
作者：
Lin DD;Kleinman JT;Wityk RJ;Gottesman RF;Hillis AE;Lee AW;Barker PB
交叉性小脑神经联系不能（CCD）是幕上卒中对侧小脑半球血流和代谢的减少，常在正电子发射断层扫描（PET）和单光子发射CT（SPECT）中报道，但很少用MR灌注技术描述。本研究旨在通过回顾性审查急性卒中患者的研究数据库，确定急性卒中中观察到的CCD的频率，这些患者通过弥散加权（DWI）和动态对比敏感性灌注MR成像（PWI）进行评价。我们回顾了301例连续的急性脑卒中患者的PWI扫描，这些患者的DWI异常均来自于一个研究数据库。通过检查达峰时间（TTP）图的不对称性，在T2加权扫描、DWI上没有小脑异常或在MR血管造影上没有椎基底动脉系统疾病，来确定同侧小脑灌注不足。在一个子集的情况下，定量分析灌注扫描进行动脉输入函数和奇异值分解（SVD）生成脑血流（CBF）地图。301例中47例（15.61%）符合CCD的标准，即TTP图上小脑灌注不对称。在定量分析中，相应的CBF减少了22.75 ± 10.94%（范围为7.45%至52.13%）。MR灌注技术可用于检测CCD，尽管本系列中的频率低于PET/SPECT文献中通常报告的频率。然而，由于其在急性卒中中的作用和无创性，MR灌注可能是PET或SPECT的可行替代方法，用于研究CCD幕上卒中的现象和临床后果。
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.