From the Department of Neurosurgery (M.S., C.H.B.v.N., O.B., G.E., L.R., J.F.), Clinical Neuroscience Center (M.S., C.H.B.v.N., M.P., O.B., S.W., G.E., A.P., A.V., A.R.L., L.R., J.F.), and Departments of Neuroradiology (M.P., A.P., A.V.), Neurology (S.W., A.R.L.), and Nuclear Medicine (A.B.), University Hospital Zurich, University of Zurich, Switzerland.
Neurology. 2018 Oct 2;91(14):e1328-e1337. doi: 10.1212/WNL.0000000000006287. Epub 2018 Sep 5.
To study blood oxygen level-dependent cerebrovascular reactivity (BOLD-CVR) as a surrogate imaging marker for crossed cerebellar diaschisis (CCD).
Twenty-five participants with symptomatic unilateral cerebrovascular steno-occlusive disease underwent a BOLD-CVR and an acetazolamide challenged (O)-HO-PET study. CCD and cerebellar asymmetry index were determined from PET and compared to BOLD-CVR quantitative values. Neurologic status at admission and outcome after 3 months were determined with NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores.
For both the BOLD-CVR and PET examination, a significant cerebellar asymmetry index was found for participants exhibiting CCD (CCD+ vs CCD-: for BOLD-CVR 13.11 ± 9.46 vs 1.52 ± 4.97, < 0.001; and for PET 7.31 ± 2.75 vs 1.68 ± 2.98, < 0.001). The area under the curve for BOLD-CVR was 0.89 (95% confidence interval: 0.75-1.0) with 0.91 sensitivity and 0.81 specificity to detect CCD. Participants exhibiting CCD were in poorer clinical condition at baseline (CCD+ vs CCD-: NIHSS 7 vs 1, = 0.003; mRS 3 vs 1, = 0.001) and after 3-month follow-up (NIHSS 2 vs 0, = 0.02; mRS 1 vs 0, = 0.04). Worse performance on both scores showed an agreement with a larger BOLD-CVR cerebellar asymmetry index. This was not found for PET.
BOLD-CVR demonstrates similar sensitivity to detect CCD as compared to (O)-HO-PET in patients with symptomatic unilateral cerebrovascular steno-occlusive disease. Furthermore, participants exhibiting CCD had a poorer baseline neurologic performance and neurologic outcome at 3 months.
This study provides Class II evidence that BOLD-CVR identifies CCD in patients with symptomatic unilateral cerebrovascular steno-occlusive disease.
研究血氧水平依赖脑血管反应性（BOLD-CVR）作为交叉性小脑失联络（CCD）的替代成像标志物。
25 名有症状的单侧脑血管狭窄闭塞性疾病患者接受了 BOLD-CVR 和乙酰唑胺挑战（O）-HO-PET 研究。从 PET 确定 CCD 和小脑不对称指数，并与 BOLD-CVR 定量值进行比较。入院时的神经状态和 3 个月后的结果通过 NIH 卒中量表（NIHSS）和改良 Rankin 量表（mRS）评分来确定。
对于 BOLD-CVR 和 PET 检查，对于表现出 CCD 的参与者，小脑不对称指数有显著差异（CCD+ vs CCD-：对于 BOLD-CVR 为 13.11±9.46 vs 1.52±4.97，<0.001；对于 PET 为 7.31±2.75 vs 1.68±2.98，<0.001）。BOLD-CVR 的曲线下面积为 0.89（95%置信区间：0.75-1.0），灵敏度为 0.91，特异性为 0.81，可用于检测 CCD。基线时表现出 CCD 的患者临床状况较差（CCD+ vs CCD-：NIHSS 为 7 分 vs 1 分，=0.003；mRS 为 3 分 vs 1 分，=0.001），3 个月随访时（NIHSS 为 2 分 vs 0 分，=0.02；mRS 为 1 分 vs 0 分，=0.04）。两项评分的较差表现与更大的 BOLD-CVR 小脑不对称指数一致。这在 PET 中并未发现。
与有症状的单侧脑血管狭窄闭塞性疾病患者的（O）-HO-PET 相比，BOLD-CVR 显示出相似的检测 CCD 的敏感性。此外，表现出 CCD 的患者在基线时的神经功能表现和 3 个月时的神经功能结局更差。
本研究提供了 II 级证据，表明 BOLD-CVR 可在有症状的单侧脑血管狭窄闭塞性疾病患者中识别出 CCD。
