Martina Sebök1, Christiaan H B van Niftrik1, Marco Piccirelli1, Oliver Bozinov1, Susanne Wegener1, Giuseppe Esposito1, Athina Pangalu1, Antonios Valavanis1, Alfred Buck1, Andreas R Luft1, Luca Regli1, Jorn Fierstra2. 1. From the Department of Neurosurgery (M.S., C.H.B.v.N., O.B., G.E., L.R., J.F.), Clinical Neuroscience Center (M.S., C.H.B.v.N., M.P., O.B., S.W., G.E., A.P., A.V., A.R.L., L.R., J.F.), and Departments of Neuroradiology (M.P., A.P., A.V.), Neurology (S.W., A.R.L.), and Nuclear Medicine (A.B.), University Hospital Zurich, University of Zurich, Switzerland. 2. From the Department of Neurosurgery (M.S., C.H.B.v.N., O.B., G.E., L.R., J.F.), Clinical Neuroscience Center (M.S., C.H.B.v.N., M.P., O.B., S.W., G.E., A.P., A.V., A.R.L., L.R., J.F.), and Departments of Neuroradiology (M.P., A.P., A.V.), Neurology (S.W., A.R.L.), and Nuclear Medicine (A.B.), University Hospital Zurich, University of Zurich, Switzerland. jorn.fierstra@usz.ch.
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.
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.
Authors: Christiaan Hendrik Bas van Niftrik; Martina Sebök; Giovanni Muscas; Marco Piccirelli; Carlo Serra; Niklaus Krayenbühl; Athina Pangalu; Oliver Bozinov; Andreas Luft; Christoph Stippich; Luca Regli; Jorn Fierstra Journal: J Cereb Blood Flow Metab Date: 2019-02-12 Impact factor: 6.200
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Authors: Christiaan Hendrik Bas van Niftrik; Marco Piccirelli; Giovanni Muscas; Martina Sebök; Joseph Arnold Fisher; Oliver Bozinov; Christoph Stippich; Antonios Valavanis; Luca Regli; Jorn Fierstra Journal: PLoS One Date: 2019-05-06 Impact factor: 3.240
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