Patay Zoltan, Parra Carlos, Hawk Harris, George Arun, Li Yimei, Scoggins Matthew, Broniscer Alberto, Ogg Robert J
Section of Neuroimaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA,
Cerebellum. 2014 Oct;13(5):580-7. doi: 10.1007/s12311-014-0575-2.
Decreased cerebral blood volume (CBV) in contralateral cerebellar gray matter (cGM) in conjunction with cerebellar white matter (cWM) damage, consistent with crossed cerebro-cerebellar diaschisis (cCCD) develop following supratentorial hemispheric stroke. In this study, we investigated the longitudinal evolution of diaschisis-related cerebellar perfusion and diffusion tensor-imaging (DTI) changes in patients after surgery for supratentorial brain tumors. Eight patients (M:F 5:3, age 8-22 years) who received surgery for supratentorial high-grade gliomas were evaluated. Initial MRI studies were performed 19-54 days postoperatively, with follow-ups at 2- to 3-month intervals. For each study, parametric maps of the cerebellum were generated and coregistered to T1-weighted images that had been previously segmented for cGM and cWM. Aggregate mean values of CBV, cerebral blood flow (CBF), and fractional anisotropy (FA) were obtained separately for cGM and cWM, and asymmetry indices (AIs) were calculated. Hemodynamic changes were more robust in cGM than in cWM. Seven patients showed decreased perfusion within cGM contralateral to the supratentorial lesion on the first postoperative study, and asymmetry was significant for both CBV (p = 0.008) and CBF (p < 0.01). For CBV, follow-up studies showed a significant trend towards recovery (p < 0.02). DTI changes were more pronounced in cWM. FA values suggested a "paradoxical" increase at initial follow-up, but steadily declined thereafter (p = 0.0003), without evidence of subsequent recovery. Diaschisis-related hemodynamic alterations within cGM appear on early postoperative studies, but CBV recovers over time. Conversely, cWM DTI changes are delayed and progressive. Although the clinical correlates of cCCD are yet to be elucidated, better understanding of longitudinal structural and hemodynamic changes within brain remote from the area of primary insult could have implications in research and clinical rehabilitative strategies.
幕上半球卒中后，对侧小脑灰质（cGM）脑血容量（CBV）降低，同时伴有小脑白质（cWM）损伤，这与交叉性大脑-小脑失联络（cCCD）相符。在本研究中，我们调查了幕上脑肿瘤手术后患者失联络相关的小脑灌注及扩散张量成像（DTI）变化的纵向演变情况。对8例接受幕上高级别胶质瘤手术的患者（男:女=5:3，年龄8 - 22岁）进行了评估。术后19 - 54天进行了首次MRI检查，并每隔2 - 3个月进行随访。对于每项研究，生成小脑的参数图，并将其与先前已分割出cGM和cWM的T1加权图像进行配准。分别获取cGM和cWM的CBV、脑血流量（CBF）和各向异性分数（FA）的总体平均值，并计算不对称指数（AI）。cGM中的血流动力学变化比cWM更显著。7例患者在术后首次检查时，幕上病变对侧的cGM灌注降低，CBV（p = 0.008）和CBF（p < 0.01）的不对称均具有显著性。对于CBV，随访研究显示有显著的恢复趋势（p < 0.02）。DTI变化在cWM中更为明显。FA值在初次随访时显示“矛盾”性升高，但此后稳步下降（p = 0.0003），且无后续恢复的证据。cGM内与失联络相关的血流动力学改变在术后早期检查中出现，但CBV随时间恢复。相反，cWM的DTI变化出现延迟且呈进行性。尽管cCCD的临床相关性尚待阐明，但更好地了解远离原发性损伤区域的脑内纵向结构和血流动力学变化可能对研究和临床康复策略具有重要意义。
