Kang Koung Mi, Sohn Chul-Ho, Choi Seung Hong, Jung Keun-Hwa, Yoo Roh-Eul, Yun Tae Jin, Kim Ji-Hoon, Park Sun-Won
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.
PLoS One. 2017 Mar 21;12(3):e0173971. doi: 10.1371/journal.pone.0173971. eCollection 2017.
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.
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.
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.
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.
动脉自旋标记（ASL）最近被引入作为一种评估脑血流动力学的无创方法。本研究的目的是评估ASL成像检测首次发生单侧幕上超急性卒中患者交叉性小脑失联络（CCD）的能力，并确定与CCD显著相关的影像学或临床因素。
我们回顾了204例卒中症状发作后8小时内接受MRI检查的连续患者。纳入标准为弥散加权图像上幕上异常，且无小脑或脑干病变、双侧幕上梗死、亚急性或慢性梗死，以及磁共振血管造影显示椎基底动脉系统疾病。对于定性分析，ASL图像中不对称性小脑灌注减低分为3级。进行定量分析以计算不对称指数（AI）。记录患者的人口统计学、临床特征和结局。还进行了单因素和多因素分析。
共有32例患者符合纳入标准，其中24例（75%）出现CCD。单因素分析显示，与CCD阴性组相比，CCD阳性组动脉闭塞更常见、弥散加权成像（DWI）病变体积更大、初始美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评分更高（均p < 0.05）。动脉闭塞的存在和初始mRS评分与AI相关（均p < 0.05）。多因素分析显示，动脉闭塞和初始mRS评分与CCD和AI显著相关。
ASL成像可在75%的超急性梗死患者中检测到CCD。我们发现，动脉闭塞、缺血性脑体积较大、初始NIHSS和mRS评分较高的患者中CCD更常见。特别是，血管闭塞和初始mRS评分似乎与超急性期CCD的病理生理学显著相关。
