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


RESULTS
A 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.


CONCLUSIONS
ASL 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.
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Koung Mi
KM
Kang
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Chul-Ho
CH
Sohn
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Seung Hong
SH
Choi
Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Keun-Hwa
KH
Jung
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Roh-Eul
RE
Yoo
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Tae Jin
TJ
Yun
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Ji-Hoon
JH
Kim
Department of Radiology, Seoul National University Boramae Hospital, Seoul, Republic of Korea.
Sun-Won
SW
Park
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002531:Cerebellum / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013113:Spin Labels; D020521:Stroke / Q000000981:diagnostic imaging*
D013113:Spin Labels