Crossed cerebellar diaschisis-related supratentorial hemodynamic and metabolic status measured by PET/MR in assessing postoperative prognosis in chronic ischemic cerebrovascular disease patients with bypass surgery

Abstract

Objective Cerebral ischemic status is an indicator of bypass surgery. Both hemodynamics and glucose metabolism are significant factors for evaluating cerebral ischemic status. The occurrence of crossed cerebellar diaschisis (CCD) is influenced by the degree of supra-tentorial perfusion and glucose metabolism reduction. This study aimed to investigate the relationship between the CCD-related supra-tentorial blood flow and metabolic status before bypass surgery in patients with chronic and symptomatic ischemic cerebrovascular disease and the prognosis of surgery. Methods Twenty-four participants with chronic ischemic cerebrovascular disease who underwent hybrid positron emission tomography (PET)/magnetic resonance (MR) before bypass surgery were included. Arterial spin labeling (ASL)-MR and FDG-PET were used to measure blood flow and metabolism, respectively. The PET images were able to distinguish CCD. The supratentorial asymmetry index (AI) and volume in the decreased blood flow region, decreased metabolism region and co-decreased region on the affected side, except for the infarct area, were respectively obtained before bypass surgery. The neurological status was determined using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. Differences between CCD-positive (CCD +) and CCD-negative (CCD−) groups were investigated. Results Fourteen (58%) of the 24 patients were diagnosed as CCD +. Before surgery, the NIHSS and mRS scores of the CCD + were significantly higher than those of the CCD− (1.0(1.0) vs. 0.0(1.0), P = 0.013; 1.0(1.5) vs. 0.0(1.5), P = 0.048). After the surgery, the NIHSS and mRS scores of the CCD + showed a significant decrease (0.0(1.0) to 0.0(0.0), P = 0.011; 0.0(0.5) to 0.0(0.0), P = 0.008). Significant differences were observed in the supra-tentorial decreased metabolism region (all Ps ≤ 0.05) between the CCD + and CCD− groups, but no differences were observed in the preprocedural decreased supratentorial blood flow region (P > 0.05). The preprocedural NIHSS score was strongly correlated with the metabolism AI value in the decreased metabolism region (r = 0.621, P = 0.001) and the co-decreased region (r = 0.571, P = 0.004). Conclusions Supratentorial blood flow and metabolism are important indicators of CCD. This study showed that CCD + patients benefited more from bypass surgery than CCD− patients. Staging based on CCD-related supra-tentorial blood flow and metabolic status by hybrid PET/MR may help to personalize treatment.

Hybrid 18F-FDG PET/MRI can Improve the Evaluation of Adult Moyamoya Disease in a “one-stop” Measurement Model

“…In this study, we did not apply semiquantitative parameters calculated using the cerebellum as a reference region for the evaluation of PET or ASL-CBF score because both cerebral hemispheres with different severity degrees are often simultaneously involved in MMD patients, which may in uence the cerebellum values of SUV and CBF [22,[39][40] , especially in severe cases [41] . All parameters of PET/MRI were carefully and independently reviewed by two experienced neuroradiologists (Qian Chen & Leilei Yuan) without knowledge of the patient's clinical information or the DSA stages.…”

Research progress of stem cell therapy for ischemic stroke

“…They can be activated and release inflammatory cytokines by recognizing various external stimuli such as glycoproteins, aggregators, cytokines, chemokines and inflammatory microenvironments (Fan Y, et al, 2018). These cytokines give rise to severe neurotoxicity, resulting in long‐term and lasting damage through overactivation of microglia (Zhang S, et al, 2019). Microglia are involved in a series of neurodegenerative diseases.…”

“…But the cell types, infusion methods and cell doses need further exploration (Hess DC, et al, 2017). Treatment is also different at various times of stroke (Qian O, et al, 2019; Zhang G‐L, et al, 2019; B BG, et al, 2020). When injected intra‐arterial, stem cells can be found in the brain, but there are safety questions.…”

“…Which can be analyzed by imaging with 15 O, 18 F and other labeled tracers of PET in small animals, so as to evaluate the course of cerebrovascular disease. PET can measure the changes of cerebral blood flow early and judge whether the tissue of cerebral ischemia area is alive or not, which is of great value to the course of disease and the evaluation of therapeutic effect (Yingying L, et al, 2017; Meina H, et al, 2019; Bixiao C, et al, 2019; Hyafil F, et al, 2016). In recent years, Micro PET has also been used in cerebral ischemia (Xiaohui D, et al, 2017).…”