Crossed Cerebellar Diaschisis: Three Case Reports Imaging Using a Tri-Modality PET/CT-MR System

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Crossed cerebellar diaschisis (CCD) is characterized by reduced oxidative metabolism, glucose utilization, and blood flow in the cerebellum, secondary to contralateral supratentorial lesions.
• Positron Emission Tomography/Magnetic Resonance Imaging (PET/MR) offers potential for enhanced visualization of intracranial lesions.

Observation:

• This study reports on three patients with CCD and neurological symptoms, investigated using a tri-modality PET/CT-MR setup.
• Abnormal cerebral fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography-Magnetic Resonance Imaging (PET/CT-MR) findings, including arterial spin-labeling (ASL) and T2-weighted images, were observed.

Findings:

• 18FDG-PET/CT identified FDG uptake in supratentorial lesions and hypometabolism with cerebellar atrophy.
• Hybrid PET/MRI provided superior anatomical localization, while ASL revealed disruptions in the cortico-ponto-cerebellar pathway.
• Pathology and clinical follow-up confirmed diagnoses of cerebral infarction, recurrent glioma, and metastasis in the three patients.

Implications:

• Multimodality radiological examinations are crucial for accurate diagnosis, management, and follow-up of supratentorial lesions causing CCD.
• Integrating MRI with PET offers advantages over CT for routine clinical assessment of CCD.
• Advanced imaging techniques like ASL enhance the understanding of pathway disruptions in CCD.