Hou Yaqin, Hu Jie, Wang Jingjuan, Yao Chenyang, Wang Zhenming, Lu Jie
Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
Cerebellum. 2024 Dec 21;24(1):18. doi: 10.1007/s12311-024-01759-x.
Crossed cerebellar diaschisis(CCD) involves reduced metabolism and blood flow in the cerebellar hemisphere contralateral to a supratentorial lesion. ASL is a valuable tool for quantifying regional cerebral blood flow. This study assesses ASL-MRI's ability to detect CCD in epilepsy using integrated F-FDG PET/MRI and compares ASL with PET images in evaluating CCD. 74 patients with drug-refractory epilepsy who underwent integrated F-FDG PET/MRI pre-surgery and CT/MRI post-surgery was analysed. Regions of interest were outlined on MRI images and simultaneously transferred to PET and ASL images. CCD detection was evaluated visually and semi-quantitatively using the absolute asymmetry index (AIabs). Out of 74 patients, PET detected CCD in 24 (32.43%) and ASL in 18 (24.32%), with no significant difference between them (P = 0.274). Based on the PET results, the ROC curve for ASL's diagnostic accuracy for CCD showed an area under the curve of 0.69 (P = 0.008), an accuracy of 75.68%, a sensitivity of 50%, a specificity of 88%, a positive predictive value (PPV) of 66.67%, and a negative predictive value (NPV) of 78.57%. Four CCD types were identified: both PET and ASL positive (16.22%), PET positive and ASL negative (16.22%), ASL positive and PET negative (8.10%), and both negative (59.46%). AIabs correlation was positive between PET and ASL in the epileptic zone (r = 0.658, P < 0.001) and cerebellum (r = 0.407, P < 0.001). In ASL CCD-positive cases, AIabs showed a negative correlation between the epileptic zone and cerebellum (r=-0.581, P = 0.011), while in both PET and ASL CCD-positive cases, AIabs correlation was positive (r = 0.670, P = 0.017). ASL can be used as a method for evaluating CCD, and when combined with FDG-PET, it can further enhance its diagnostic accuracy for CCD. In CCD-positive cases, a notable discrepancy was observed: no correlation in PET images but a correlation in ASL images between the supratentorial epileptic zone and contralateral cerebellar hemisphere, indicating CCD might be linked to regional cerebral blood flow changes.
交叉性小脑失联络（CCD）是指幕上病变对侧小脑半球代谢和血流减少。动脉自旋标记（ASL）是定量评估局部脑血流的重要工具。本研究旨在评估ASL-MRI在癫痫患者中检测CCD的能力，并在评估CCD时将ASL与PET图像进行比较。分析了74例药物难治性癫痫患者，这些患者术前接受了F-FDG PET/MRI检查，术后接受了CT/MRI检查。在MRI图像上勾勒出感兴趣区域，并同时将其转移到PET和ASL图像上。使用绝对不对称指数（AIabs）对CCD检测进行视觉和半定量评估。74例患者中，PET检测到24例（32.43%）存在CCD，ASL检测到18例（24.32%），两者之间无显著差异（P = 0.274）。基于PET结果，ASL诊断CCD的ROC曲线下面积为0.69（P = 0.008），准确率为75.68%，敏感度为50%，特异度为88%，阳性预测值（PPV）为66.67%，阴性预测值（NPV）为78.57%。识别出四种CCD类型：PET和ASL均阳性（16.22%）、PET阳性而ASL阴性（16.22%）、ASL阳性而PET阴性（8.10%）以及两者均阴性（59.46%）。癫痫灶区域PET与ASL的AIabs呈正相关（r = 0.658，P < 0.001），小脑区域两者也呈正相关（r = 0.407，P <
