Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Cerebellum. 2020 Dec;19(6):824-832. doi: 10.1007/s12311-020-01174-y.
Crossed cerebellar diaschisis (CCD) can be associated with impaired cerebrovascular reactivity (CVR) and poor clinical outcome, but whether this holds true for patients with diffuse glioma is unknown. With blood oxygenation level-dependent (BOLD)-CVR imaging, we determined the presence of CCD in patients with diffuse glioma and investigated its relationship with cerebrovascular reactivity and clinical outcome. For eighteen enrolled subjects (nineteen datasets) with diffuse glioma, CCD was deferred from BOLD-CVR using a predetermined cerebellar asymmetry index (CAI) cutoff value of 6.0%. A FET-PET study was done as a verification of the CCD diagnosis. BOLD-CVR values as well as clinical performance scores (i.e., Karnofsky performance score (KPS), disability rating scale (DRS), and modified Rankin scale (mRS)) by BOLD-CVR scan at 3-month clinical follow-up were assessed and compared for the CCD-positive and CCD-negative group. CCD was present in 26.3% of subjects and strongly associated with impaired BOLD-CVR of the affected (i.e., the hemisphere harboring the glioma) and unaffected supratentorial hemisphere (CCD(+) vs. CCD(-): 0.08 ± 0.11 vs. 0.18 ± 0.04; p = 0.007 and 0.08 ± 0.12 vs. 0.19 ± 0.04; p = 0.007, respectively). This finding was independent of tumor volume (p = 0.48). Furthermore, poorer initial (by scan) clinical performance scores at follow-up were found for the CCD(+) group. The presence of crossed cerebellar diaschisis in patients with diffuse glioma is associated with impaired supratentorial cerebrovascular reactivity and worse clinical outcome.
交叉性小脑失联络（CCD）可与脑血管反应性（CVR）受损和不良临床结局相关，但这是否适用于弥漫性胶质瘤患者尚不清楚。我们使用基于血氧水平依赖（BOLD）的 CVR 成像来确定弥漫性胶质瘤患者中是否存在 CCD，并研究其与脑血管反应性和临床结局的关系。对于 18 名患有弥漫性胶质瘤的入组患者（19 个数据集），使用预先确定的小脑不对称指数（CAI）截断值 6.0%来推断 CCD。进行 FET-PET 研究以验证 CCD 诊断。评估和比较了 BOLD-CVR 扫描时的 BOLD-CVR 值以及 3 个月临床随访时的临床表现评分（即卡氏行为状态评分（KPS）、残疾评定量表（DRS）和改良 Rankin 量表（mRS）），并将其用于 CCD 阳性和 CCD 阴性组。26.3%的患者存在 CCD，并且与受累（即存在胶质瘤的半球）和未受累的大脑半球（CCD(+) 与 CCD(-)：0.08 ± 0.11 与 0.18 ± 0.04；p=0.007 和 0.08 ± 0.12 与 0.19 ± 0.04；p=0.007）的 BOLD-CVR 受损密切相关。这一发现与肿瘤体积无关（p=0.48）。此外，在随访时，CCD(+) 组的初始（通过扫描）临床表现评分较差。弥漫性胶质瘤患者存在交叉性小脑失联络与大脑半球脑血管反应性受损和临床结局较差相关。
