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Crossed cerebellar hyperperfusion in patients with seizure-related cerebral cortical lesions: an evaluation with arterial spin labelling perfusion MR imaging

  • Jungho Won
  • Dae Seob Choi
  • Seok Jin Hong
  • Hwa Seon Shin
  • Hye Jin Baek
  • Ho Cheol Choi
  • Minjung Kim
  • Rock Bum Kim
MAGNETIC RESONANCE IMAGING
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Abstract

Purpose

Crossed cerebellar (CC) diaschisis refers to a decrease in cerebellar perfusion in the presence of contralateral supratentorial lesions. Most of the previous studies have examined stroke patients. In contrast to strokes, seizure-related cerebral cortical lesions (SCCLs) usually show hyperperfusion, and therefore, cerebellar perfusion patterns are expected to be different from those of strokes. With arterial spin labelling (ASL), we evaluated the cerebellar perfusion status in patients with SCCLs.

Materials and methods

Using a search of the recent database over the last 31 months, 26 patients were enrolled in this study. The inclusion criteria were as follows: (1) a history of seizures, (2) MR examination taken within 24 h from the last seizure, (3) the presence of SCCLs on T2/FLAIR or DWI, (4) hyperperfusion in the corresponding areas of SCCLs on ASL, and (5) no structural abnormality in the cerebellum. The perfusion status in the contralateral cerebellum was evaluated and categorized as hyper-, iso- and hypoperfusion. The asymmetric index (AI) of cerebellar perfusion was calculated by ROI measurement of the signal intensity on ASL.

Results

The mean time between the last seizure and MR examinations was 5 h 30 min. CC hyperperfusion was observed in 17 patients (65.4%), hypoperfusion in 7 (26.9%) and isoperfusion in 2 (7.7%). Regarding the location of SCCLs, CC hyperperfusion was more frequent (71.4 vs. 58.3%), and the mean AI was higher (42.0 vs. 11.5) when the lesion involved the frontal lobe.

Conclusions

In patients with SCCLs, CC hyperperfusion occurred more often than hypo- and isoperfusion, especially when the lesions involved the frontal lobe.

Keywords

Seizure Cerebral cortical lesion Perfusion MR Arterial spin labelling (ASL) Crossed cerebellar diaschisis Crossed cerebellar hyperperfusion 

Notes

Acknowledgements

The authors would like to thank ‘Wiley Editing Services’ for the English: http://authorservices.wiley.com/bauthor/english_language.asp.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional review board (IRB) after its approval and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Our IRB determined that patient approval and informed consent were not required because of retrospectively reviewing images and records.

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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Gyeongsang National University HospitalGyeongsang National University School of MedicineJinjuRepublic of Korea
  2. 2.Gyeongsang Institute of Health ScienceGyeongsang National University School of MedicineJinjuRepublic of Korea
  3. 3.Department of NeurologyGyeongsang National University School of MedicineJinjuRepublic of Korea
  4. 4.Department of Preventive MedicineGyeongsang National University School of MedicineJinjuRepublic of Korea

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