La radiologia medica

, Volume 123, Issue 11, pp 843–850 | Cite as

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

  • Jungho Won
  • Dae Seob ChoiEmail author
  • Seok Jin Hong
  • Hwa Seon Shin
  • Hye Jin Baek
  • Ho Cheol Choi
  • Minjung Kim
  • Rock Bum Kim



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.


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.


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


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



The authors would like to thank ‘Wiley Editing Services’ for the English:

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.


  1. 1.
    Ramnani N (2006) The primate cortico-cerebellar system: anatomy and function. Nat Rev Neurosci 7:511–522CrossRefPubMedGoogle Scholar
  2. 2.
    Gold L, Lauritzen M (2002) Neuronal deactivation explains decreased cerebellar blood flow in response to focal cerebral ischemia or suppressed neocortical function. Proc Natl Acad Sci U S A 99:7699–7704CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Graffeo CS, Snyder KA, Nasr DM et al (2016) Prognostic and mechanistic factors characterizing seizure-associated crossed cerebellar diaschisis. Neurocrit Care 24:258–263CrossRefPubMedGoogle Scholar
  4. 4.
    Bailly P, Bazire A, Prat G et al (2017) Crossed cerebellar diaschisis in status epilepticus. Presse Med 46:117–118CrossRefPubMedGoogle Scholar
  5. 5.
    Pantano P, Baron J, Samson Y et al (1986) Crossed cerebellar diaschisis: further studies. Brain 109:677–794CrossRefPubMedGoogle Scholar
  6. 6.
    Cianfoni A, Caulo M, Cerase A et al (2013) Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol 82:1964–1972CrossRefPubMedGoogle Scholar
  7. 7.
    Wolf RL, Detre JA (2007) Clinical neuroimaging using arterial spin-labeled perfusion magnetic resonance imaging. Neurotherapeutics 4:346–359CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Detre JA, Rao H, Wang DJ et al (2012) Applications of arterial spin labeled MRI in the brain. J Magn Reson Imaging 35:1026–1037CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chen Y, Wang DJ, Detre JA (2011) Test–retest reliability of arterial spin labeling with common labeling strategies. J Magn Reson Imaging 33:940–949CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Deibler AR, Pollock JM, Kraft RA et al (2008) Arterial spin-labeling in routine clinical practice, part 2: hypoperfusion patterns. AJNR Am J Neuroradiol 29:1235–1241CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Matsuura K, Maeda M, Okamoto K et al (2015) Usefulness of arterial spin-labeling images in periictal state diagnosis of epilepsy. J Neurol Sci 359:424–429CrossRefPubMedGoogle Scholar
  12. 12.
    Pizzini FB, Farace P, Manganotti P et al (2013) Cerebral perfusion alterations in epileptic patients during peri-ictal and post-ictal phase: PASL vs DSC-MRI. Magn Reson Imaging 31:1001–1005CrossRefPubMedGoogle Scholar
  13. 13.
    Miyaji Y, Yokoyama M, Kawabata Y et al (2014) Arterial spin-labeling magnetic resonance imaging for diagnosis of late seizure after stroke. J Neurol Sci 339:87–90CrossRefPubMedGoogle Scholar
  14. 14.
    Chen S, Guan M, Lian H et al (2014) Crossed cerebellar diaschisis detected by arterial spin-labeled perfusion magnetic resonance imaging in subacute ischemic stroke. J Stroke Cerebrovasc Dis 23:2378–2383CrossRefPubMedGoogle Scholar
  15. 15.
    Kang KM, Sohn CH, Kim BS et al (2015) Correlation of asymmetry indices measured by arterial spin-labeling MR imaging and SPECT in patients with crossed cerebellar diaschisis. AJNR Am J Neuroradiol 36:1662–1668CrossRefPubMedGoogle Scholar
  16. 16.
    Lin DD, Kleinman JT, Wityk RJ et al (2009) Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. AJNR Am J Neuroradiol 30:710–715CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kang KM, Sohn C, Choi SH et al (2017) Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging. PLoS ONE 12:e0173971CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Varoquaux A, Rager O, Lovblad K et al (2013) Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging 40:842–852CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Oppo K, Leen E, Angerson WJ et al (1998) Doppler perfusion index: an interobserver and intraobserver reproducibility study. Radiology 208:453–457CrossRefPubMedGoogle Scholar
  20. 20.
    Takasawa M, Watanabe M, Yamamoto S et al (2002) Prognostic value of subacute crossed cerebellar diaschisis: single-photon emission CT study in patients with middle cerebral artery territory infarct. AJNR Am J Neuroradiol 23:189–193PubMedGoogle Scholar
  21. 21.
    Shinohara Y, Kato A, Kuya K et al (2017) Perfusion MR imaging using a 3D pulsed continuous arterial spin-labeling method for acute cerebral infarction classified as branch atheromatous disease involving the lenticulostriate artery territory. AJNR Am J Neuroradiol 38:1550–1554CrossRefPubMedGoogle Scholar
  22. 22.
    Won JH, Lee JD, Chung TS et al (1996) Increased contralateral cerebellar uptake of technetium-99 m-HMPAO on ictal brain SPECT. J Nucl Med 37:426–429PubMedGoogle Scholar
  23. 23.
    Marks DA, Katz A, Hoffer P et al (1992) Localization of extratemporal epileptic foci during ictal single photon emission computed tomography. Ann Neurol 31:250–255CrossRefPubMedGoogle Scholar
  24. 24.
    Shin WC, Hong SB, Tae WS et al (2001) Ictal hyperperfusion of cerebellum and basal ganglia in temporal lobe epilepsy: SPECT subtraction with MRI coregistration. J Nucl Med 42:853–858PubMedGoogle Scholar
  25. 25.
    Poretti A, Boltshauser E (2012) Crossed cerebro-cerebellar diaschisis. Neuropediatrics 43:53–54CrossRefPubMedGoogle Scholar
  26. 26.
    Long B, Koyfman A (2017) Clinical mimics: an emergency medicine-focused review of stroke mimics. J Emerg Med 52:176–183CrossRefPubMedGoogle Scholar
  27. 27.
    Deibler AR, Pollock JM, Kraft RA et al (2008) Arterial spin-labeling in routine clinical practice, part 3: hyperperfusion patterns. AJNR Am J Neuroradiol 29:1428–1435CrossRefPubMedPubMedCentralGoogle Scholar

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

Personalised recommendations