Cerebellovascular Disease: Magnetic Resonance Imaging

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Cerebellovascular diseases are often challenging to diagnose using conventional imaging.
• Posterior fossa ischemia can be clinically occult, leading to delayed diagnosis and treatment.
• Advanced Magnetic Resonance (MR) Imaging (MRI) offers potential for improved detection and characterization.

Purpose of the Study:

• To detail cerebellovascular diseases using advanced MR imaging (MRI).
• To translate advanced MRI findings into routine clinical practice.
• To investigate cerebellar arterial perfusion territories and infarction patterns.

Main Methods:

• Super-selective arterial spin labelling (ASL) MRI with vertebral and carotid artery labelling.
• High-field (7T) post-mortem MRI for detailed anatomical analysis.
• Volume (3D) clinical MRI for evaluating infarction patterns.

Main Results:

• Cerebellar arterial perfusion territories were successfully imaged.
• The imaging pattern of cerebellar infarctions was elucidated.
• "Cerebellar cortical infarct cavities" were described as a frequent, incidental finding.
• These cavities are a marker for atherosclerotic and thromboembolic cerebrovascular disease.
• Most patients with these cavities had no prior history of vertebrobasilar transient ischemic attack (TIA) or stroke.

Conclusions:

• Advanced MRI techniques, including ASL and 7T imaging, enhance the understanding of cerebellovascular diseases.
• "Cerebellar cortical infarct cavities" represent a common manifestation of clinically silent posterior fossa ischemia.
• These findings underscore the high incidence of occult ischemia in the posterior circulation and its association with cerebrovascular disease.