Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
Ann Nucl Med. 2022 Sep;36(9):812-822. doi: 10.1007/s12149-022-01766-0. Epub 2022 Jul 5.
Cerebral ischemic status is an indicator of bypass surgery. Both hemodynamics and glucose metabolism are significant factors for evaluating cerebral ischemic status. The occurrence of crossed cerebellar diaschisis (CCD) is influenced by the degree of supra-tentorial perfusion and glucose metabolism reduction. This study aimed to investigate the relationship between the CCD-related supra-tentorial blood flow and metabolic status before bypass surgery in patients with chronic and symptomatic ischemic cerebrovascular disease and the prognosis of surgery.
Twenty-four participants with chronic ischemic cerebrovascular disease who underwent hybrid positron emission tomography (PET)/magnetic resonance (MR) before bypass surgery were included. Arterial spin labeling (ASL)-MR and FDG-PET were used to measure blood flow and metabolism, respectively. The PET images were able to distinguish CCD. The supratentorial asymmetry index (AI) and volume in the decreased blood flow region, decreased metabolism region and co-decreased region on the affected side, except for the infarct area, were respectively obtained before bypass surgery. The neurological status was determined using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. Differences between CCD-positive (CCD +) and CCD-negative (CCD-) groups were investigated.
Fourteen (58%) of the 24 patients were diagnosed as CCD +. Before surgery, the NIHSS and mRS scores of the CCD + were significantly higher than those of the CCD- (1.0(1.0) vs. 0.0(1.0), P = 0.013; 1.0(1.5) vs. 0.0(1.5), P = 0.048). After the surgery, the NIHSS and mRS scores of the CCD + showed a significant decrease (0.0(1.0) to 0.0(0.0), P = 0.011; 0.0(0.5) to 0.0(0.0), P = 0.008). Significant differences were observed in the supra-tentorial decreased metabolism region (all Ps ≤ 0.05) between the CCD + and CCD- groups, but no differences were observed in the preprocedural decreased supratentorial blood flow region (P > 0.05). The preprocedural NIHSS score was strongly correlated with the metabolism AI value in the decreased metabolism region (r = 0.621, P = 0.001) and the co-decreased region (r = 0.571, P = 0.004).
Supratentorial blood flow and metabolism are important indicators of CCD. This study showed that CCD + patients benefited more from bypass surgery than CCD- patients. Staging based on CCD-related supra-tentorial blood flow and metabolic status by hybrid PET/MR may help to personalize treatment.
脑缺血状态是旁路手术的一个指标。血流动力学和葡萄糖代谢都是评估脑缺血状态的重要因素。交叉性小脑失联络（CCD）的发生受到大脑上灌注和葡萄糖代谢减少程度的影响。本研究旨在探讨慢性症状性缺血性脑血管病患者旁路手术前 CCD 相关大脑上血流和代谢状态与手术预后的关系。
本研究纳入了 24 名接受过杂交正电子发射断层扫描（PET）/磁共振（MR）检查的慢性缺血性脑血管病患者。动脉自旋标记（ASL）-MR 和 FDG-PET 分别用于测量血流和代谢。PET 图像可以区分 CCD。分别在旁路手术前获得大脑上不对称指数（AI）和受影响侧血流量减少区域、代谢减少区域和共同减少区域的体积，除梗死区域外。使用国立卫生研究院卒中量表（NIHSS）和改良 Rankin 量表（mRS）评分来确定神经状态。研究了 CCD 阳性（CCD+）和 CCD 阴性（CCD-）组之间的差异。
24 名患者中有 14 名（58%）被诊断为 CCD+。手术前，CCD+的 NIHSS 和 mRS 评分明显高于 CCD-（1.0（1.0）比 0.0（1.0），P=0.013；1.0（1.5）比 0.0（1.5），P=0.048）。手术后，CCD+的 NIHSS 和 mRS 评分明显下降（0.0（1.0）至 0.0（0.0），P=0.011；0.0（0.5）至 0.0（0.0），P=0.008）。在 CCD+和 CCD-组之间，大脑上代谢减少区域的大脑上代谢减少区域存在显著差异（所有 P 值均≤0.05），但在术前大脑上血流减少区域无差异（P>0.05）。术前 NIHSS 评分与代谢减少区域（r=0.621，P=0.001）和共同减少区域（r=0.571，P=0.004）的代谢 AI 值呈强相关。
大脑上血流和代谢是 CCD 的重要指标。本研究表明，与 CCD-患者相比，CCD+患者从旁路手术中获益更多。基于杂交 PET/MR 的 CCD 相关大脑上血流和代谢状态的分期可能有助于个性化治疗。
