Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular
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ORIGINAL ARTICLE
Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome Martina Sebök 1,2 & Christiaan Hendrik Bas van Niftrik 1,2 & Matthias Halter 1,2 & Aimee Hiller 1,2 & Katharina Seystahl 2,3 & Athina Pangalu 2,4 & Michael Weller 2,3 & Christoph Stippich 2,4 & Luca Regli 1,2 & Jorn Fierstra 1,2
# The Author(s) 2020
Abstract Crossed cerebellar diaschisis (CCD) can be associated with impaired cerebrovascular reactivity (CVR) and poor clinical outcome, but whether this holds true for patients with diffuse glioma is unknown. With blood oxygenation level–dependent (BOLD)-CVR imaging, we determined the presence of CCD in patients with diffuse glioma and investigated its relationship with cerebrovascular reactivity and clinical outcome. For eighteen enrolled subjects (nineteen datasets) with diffuse glioma, CCD was deferred from BOLD-CVR using a predetermined cerebellar asymmetry index (CAI) cutoff value of 6.0%. A FET-PET study was done as a verification of the CCD diagnosis. BOLD-CVR values as well as clinical performance scores (i.e., Karnofsky performance score (KPS), disability rating scale (DRS), and modified Rankin scale (mRS)) by BOLD-CVR scan at 3-month clinical follow-up were assessed and compared for the CCD-positive and CCD-negative group. CCD was present in 26.3% of subjects and strongly associated with impaired BOLD-CVR of the affected (i.e., the hemisphere harboring the glioma) and unaffected supratentorial hemisphere (CCD(+) vs. CCD(−): 0.08 ± 0.11 vs. 0.18 ± 0.04; p = 0.007 and 0.08 ± 0.12 vs. 0.19 ± 0.04; p = 0.007, respectively). This finding was independent of tumor volume (p = 0.48). Furthermore, poorer initial (by scan) clinical performance scores at follow-up were found for the CCD(+) group. The presence of crossed cerebellar diaschisis in patients with diffuse glioma is associated with impaired supratentorial cerebrovascular reactivity and worse clinical outcome. Keywords BOLD fMRI . Cerebrovascular reactivity . Supratentorial hemodynamic . Crossed cerebellar diaschisis . Diffuse glioma
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12311-020-01174-y) contains supplementary material, which is available to authorized users. * Martina Sebök [email protected] 1
Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
2
Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
3
Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
4
Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
In patients with diffuse glioma, crossed cerebellar diaschisis (CCD)—a depression of cerebral blood flow and metabolism in the cerebellar hemisphere contralateral to the supratentorial tumor—may potentially have important clinical and progno
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