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Crossed cerebellar diaschisis after stroke: can perfusion-weighted MRI show functional inactivation?
Vince I Madai1, Andreas Altaner, Katharina L Stengl
1Department of Neurology and Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany.
Abstract:
In this study, we aimed to assess the detection of crossed cerebellar diaschisis (CCD) following stroke by perfusion-weighted magnetic resonance imaging (PW-MRI) in comparison with positron emission tomography (PET). Both PW-MRI and 15O-water-PET were performed in acute and subacute hemispheric stroke patients. The degree of CCD was defined by regions of interest placed in the cerebellar hemispheres ipsilateral (I) and contralateral (C) to the supratentorial lesion. An asymmetry index (AI=C/I) was calculated for PET-cerebral blood flow (CBF) and MRI-based maps of CBF, cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The resulting AI values were compared by Bland-Altman (BA) plots and receiver operating characteristic analysis to detect the degree and presence of CCD. A total of 26 imaging procedures were performed (median age 57 years, 20/26 imaged within 48 hours after stroke). In BA plots, all four PW-MRI maps could not reliably reflect the degree of CCD. In receiver operating characteristic analysis for detection of CCD, PW-CBF performed poorly (accuracy 0.61), whereas CBV, MTT, and TTP failed (accuracy <0.60). On the basis of our findings, PW-MRI at 1.5 T is not suited to depict CCD after stroke.
Insights
Perfusion-weighted MRI (PW-MRI) is not suitable for detecting crossed cerebellar diaschisis (CCD) after stroke. Positron emission tomography (PET) remains the preferred imaging method for assessing this condition.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Crossed cerebellar diaschisis (CCD) is a condition that can occur after a stroke.
- Accurate detection of CCD is crucial for understanding stroke-related neurological deficits.
Purpose of the Study:
- To evaluate the effectiveness of perfusion-weighted magnetic resonance imaging (PW-MRI) in detecting crossed cerebellar diaschisis (CCD) following stroke.
- To compare PW-MRI performance against 15O-water-PET, a standard imaging technique.
Main Methods:
- Both PW-MRI and 15O-water-PET were performed on patients with acute and subacute hemispheric stroke.
- An asymmetry index (AI) was calculated using regions of interest in the cerebellum for PET-cerebral blood flow (CBF) and MRI-derived maps (CBF, CBV, MTT, TTP).
- Bland-Altman plots and receiver operating characteristic (ROC) analysis were used to compare the methods and assess CCD detection.
Main Results:
- Bland-Altman plots indicated that PW-MRI maps could not reliably reflect the degree of CCD.
- ROC analysis showed poor performance for PW-CBF (accuracy 0.61) and even lower accuracy for CBV, MTT, and TTP (accuracy <0.60) in detecting CCD.
- These findings suggest PW-MRI is not well-suited for depicting CCD.
Conclusions:
- Perfusion-weighted MRI at 1.5 Tesla is not adequate for depicting crossed cerebellar diaschisis after stroke.
- Positron emission tomography (PET) remains a more reliable method for assessing CCD in stroke patients.
