PT  - JOURNAL ARTICLE
AU  - Lin, D.D.M.
AU  - Kleinman, J.T.
AU  - Wityk, R.J.
AU  - Gottesman, R.F.
AU  - Hillis, A.E.
AU  - Lee, A.W.
AU  - Barker, P.B.
TI  - Crossed Cerebellar Diaschisis in Acute Stroke Detected by Dynamic Susceptibility Contrast MR Perfusion Imaging
AID  - 10.3174/ajnr.A1435
DP  - 2009 Apr 01
TA  - American Journal of Neuroradiology
PG  - 710--715
VI  - 30
IP  - 4
4099  - http://www.ajnr.org/content/30/4/710.short
4100  - http://www.ajnr.org/content/30/4/710.full
SO  - Am. J. Neuroradiol.2009 Apr 01; 30
AB  - BACKGROUND AND PURPOSE: Crossed cerebellar diaschisis (CCD), the decrease in blood flow and metabolism in the cerebellar hemisphere contralateral to a supratentorial stroke, is frequently reported on positron-emission tomography (PET) and single-photon emission CT (SPECT) but is rarely described with MR perfusion techniques. This study was undertaken to determine the frequency of CCD observed in acute stroke by retrospective review of a research data base of patients with acute stroke evaluated by diffusion-weighted (DWI) and dynamic contrast susceptibility perfusion MR imaging (PWI).MATERIALS AND METHODS: PWI scans of 301 consecutive patients with acute stroke and positive DWI abnormality from a research data base were reviewed. Contralateral cerebellar hypoperfusion was identified by inspection of time-to-peak (TTP) maps for asymmetry with an absence of cerebellar abnormalities on T2-weighted scans, DWI, or disease of the vertebrobasilar system on MR angiography. In a subset of the cases, quantitative analysis of perfusion scans was performed using an arterial input function and singular value decomposition (SVD) to generate cerebral blood flow (CBF) maps.RESULTS: A total of 47 of 301 cases (15.61%) met the criteria of CCD by asymmetry of cerebellar perfusion on TTP maps. On quantitative analysis, there was corresponding reduction of CBF by 22.75 ± 10.94% (range, 7.45% to 52.13%) of the unaffected cerebellar hemisphere).CONCLUSIONS: MR perfusion techniques can be used to detect CCD, though the frequency presented in this series is lower than that commonly reported in the PET/SPECT literature. Nevertheless, with its role in acute stroke and noninvasive nature, MR perfusion may be a viable alternative to PET or SPECT to study the phenomenon and clinical consequences of supratentorial stroke with CCD.