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BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis


Sebök, Martina; van Niftrik, Christiaan H B; Piccirelli, Marco; Bozinov, Oliver; Wegener, Susanne; Esposito, Giuseppe; Pangalu, Athina; Valavanis, Antonios; Buck, Alfred; Luft, Andreas R; Regli, Luca; Fierstra, Jorn (2018). BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis. Neurology, 91(14):e1328-e1337.

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 (O)-HO-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, < 0.001; and for PET 7.31 ± 2.75 vs 1.68 ± 2.98, < 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, = 0.003; mRS 3 vs 1, = 0.001) and after 3-month follow-up (NIHSS 2 vs 0, = 0.02; mRS 1 vs 0, = 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 (O)-HO-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.

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 (O)-HO-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, < 0.001; and for PET 7.31 ± 2.75 vs 1.68 ± 2.98, < 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, = 0.003; mRS 3 vs 1, = 0.001) and after 3-month follow-up (NIHSS 2 vs 0, = 0.02; mRS 1 vs 0, = 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 (O)-HO-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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neuroradiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2 October 2018
Deposited On:21 Sep 2018 13:02
Last Modified:11 Jan 2019 13:35
Publisher:Lippincott Williams & Wilkins
ISSN:0028-3878
OA Status:Closed
Publisher DOI:https://doi.org/10.1212/WNL.0000000000006287
PubMed ID:30185447

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Language: English
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Embargo till: 2019-09-05