BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

Neurology. 2018 Oct 2;91(14):e1328-e1337. doi: 10.1212/WNL.0000000000006287. Epub 2018 Sep 5.

Abstract

Objective: To study blood oxygen level-dependent cerebrovascular reactivity (BOLD-CVR) as a surrogate imaging marker for crossed cerebellar diaschisis (CCD).

Methods: Twenty-five participants with symptomatic unilateral cerebrovascular steno-occlusive disease underwent a BOLD-CVR and an acetazolamide challenged (15O)-H2O-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.

Results: 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, p < 0.001; and for PET 7.31 ± 2.75 vs 1.68 ± 2.98, p < 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, p = 0.003; mRS 3 vs 1, p = 0.001) and after 3-month follow-up (NIHSS 2 vs 0, p = 0.02; mRS 1 vs 0, p = 0.04). Worse performance on both scores showed an agreement with a larger BOLD-CVR cerebellar asymmetry index. This was not found for PET.

Conclusions: BOLD-CVR demonstrates similar sensitivity to detect CCD as compared to (15O)-H2O-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.

Classification of evidence: This study provides Class II evidence that BOLD-CVR identifies CCD in patients with symptomatic unilateral cerebrovascular steno-occlusive disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging*
  • Brain / physiopathology*
  • Cerebellar Diseases / diagnostic imaging*
  • Cerebellar Diseases / etiology*
  • Cerebellar Diseases / physiopathology
  • Cerebrovascular Circulation
  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / diagnostic imaging
  • Cerebrovascular Disorders / physiopathology
  • Constriction, Pathologic / complications
  • Constriction, Pathologic / diagnostic imaging
  • Constriction, Pathologic / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Image Interpretation, Computer-Assisted
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Oxygen / blood
  • Oxygen Radioisotopes
  • Positron-Emission Tomography
  • Prospective Studies
  • Radiopharmaceuticals
  • Sensitivity and Specificity

Substances

  • Oxygen Radioisotopes
  • Radiopharmaceuticals
  • Oxygen