| Background and perpouseDiaschisis refers to a portion of the brain injury with loss of excitatory impulses spread, causing the nervous system of decreased response to stimuli of other specific areas, and the dysfunction is sudden. There is a neural anatomy link between the injury area and the influence area. Crossed cerebellar diaschisis(CCD) is an usual kind of diaschisis, refers to the cortical-pons-cerebellar pathway (CPC)interrupted in the supratentorial stroke, causing the decrease in blood flow and metabolism in the cerebellar hemisphere. Most scholars believe that CCD is related to CPC injury, and some scholars believe that the cerebellar hemodynamic changes in patients and/or delayed neuronal death is related to CCD. Supratentorial cerebral infarction is frequently reported on positron-emission tomography (PET) and single-photon emission computer tomography (SPECT), and both use regional cerebral blood flow and oxygen extraction fraction and other parameters to diagnose. However, PET and SPECT has radiation and the are expensive. With the rapid development of imaging techniques, magnetic resonance perfusion-weighted imaging (PWI) is nevertheless an attractive alternative to PET because it is less complicated, is less expensive, does not involve radiation, and has similar results with PET/SPECT as a functional imaging, more suitable for the study of CCD. So far, it is rarely described with MR perfusion techniques at home and abroad. Using brain PWI in the patients with unilateral supratentorial cerebral artery territory infarction, this study was undertaken to determine the significance of PWI in the occurrence of CCD, and the effect between CCD and prognosis and functional rehabilitation in cerebral infarction. Materials and methods81 patients with unilateral supratentorial infarction were collected in our hospital from December 2009 to January 2011,49 males and 32 female, aged 36-85 year, mean age was 61.89±11.77 year. The clinical manifestations was slurred speech, numbness of the mouth askew, unilateral limb weakness, apraxia. The inclusion criteria were all cases occurred supratentorial lesions in the blood supply area of middle cerebral artery of brain parenchyma and had supratentorial lesions. Exclusion criteria were:MRA (magnetic resonance angiograthy) check has intracranial vertebral-basilar artery vascular lesions; MRI scan and DWI scan has cerebellar hemisphere lesion itself; MRI scan accompanied by other intracranial diseases. Acute group,23 males and 18 females, aged 40 to 86 years, mean age 63.17±13.13 years, onset time of 6 hours to 3 days; subacute stage,14 male and 5 females, aged 35 to 74 years, mean age 60.0±11.15 years, onset time of 4 days -7 days; chronic stage,12 males and 9 females, aged 46 to 81 years,mean age 61.1±9.48 years, onset time of 7 days-2 month. At the same time period,6 males and 4 females were selected as control group, aged 45-79 years, mean age 64.5±10.05 years, ruled out intracranial disease and no clinical symptoms of the nervous system of volunteers. All the patients and the control group underwent conventional MRI scan, DWI, MRA, and PWI scans. Application of Siemens 3.0 Trio Tim I-class MR scanner, it was scan by perfusion imaging. The images of all cases and controls group are processed by through the Siemens Syngo processing workstation analysis software. It detected the supratentorial DWI lesion in difusssion weighted imaging, the cerebellum region of interest, and the mirror side of the relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV), relative time to peak (rTTP), relative mean transit time (rMTT) by brain perfusion imaging. The perfusion index of cerebellar hemispheres was calculated. These data was calculated:the difference of bilateral cerebellar rTTP, rMTT, rCBF, rCBV, cerebellar hemisphere asymmetry index (AI). All data are analysed by SPSS17.0 package in statistics, and the quantitative data compares of between groups use analysis of variance; continuous variables of negative group and positive group using paired samples t test was used for statistical analysis; using Pearson correlation test to analysis the variables correlation, and p <0.05 as statistically significant difference.ResultsControl group:the perfusion index of the bilateral cerebellar hemispheres is detected no statistically significant difference (t=0.132, p> 0.05).Acute group:17 patients in 41 cases (41.46%) has asymmetry of cerebellar hypoperfusion (positive group),24 patients was not (negative group); Subacute group: 7 patients in 19 cases (36.84%) has asymmetry of cerebellar hypoperfusion,12 patients was not (negative group); Chronic group:11 patients in 21 cases (52.38%) has asymmetry of cerebellar hypoperfusion (positive group),10 patients was not (negative group). Relative to ipsilateral cerebellar hemisphere of supratentorial infarction, the positive patients in the three group are rTTP extension, rCBF and rCBV decrease in contralateral (p<0.05). However, the extended rMTT of positive cases has no statistically significant difference in the subacute and chronic group (p <0.05). The supratentorial infarction volume in positive cases is larger than negative in acute and chronic group, the difference has statistically significant difference (p <0.05). In subacute group,the difference between positive and negative cases has no statistically significant difference (p<0.05). The cases of positive and negative in acute and chronic group have no significant difference in the age. But the age of positive cases are older than negative in subacute group, it has statistically significant difference.The difference between the infarction volume and the changes of rCBV, rCBF, rTTP of bilaterai cerebellum has slight linear positive correlation, it has statistically significant difference; The difference between the infarction volume and the changes of rMTT has no significant correlation and no statistically significant difference.Cerebellar hemispheric asymmetry index in positive cases has no significant correlation with the supratentorial infarction volume in subacute group, but highly linear positive correlation with chronic.The comparison of AI value in Acute, subacute,chronic phase cerebral infarction,the contralateral cerebellar hemisphere hypoperfusion degree of the acute and subacute, chronic phase has no significant change in AI, that is, contralateral cerebellar hemisphere AI has no significant differences.CCD is more likely occur in chronic phase than acute and subacute phase, and the patients with muscle strength assessed as 1-3 is more likely occurrence than upper grade 3, and the patients with grade 0 is the highest occurrence. The occurrence in upper grade 3 is 26.7% in acute phase; at grade 1-3 was 43.5%; at grade 0 was 75%. In subacute phase, at upper grade 3 was 21.4%, at grade1-3 was 50%, at grade1-3, only 1 in 19 patients occur. In chronic phase, at upper grade 3 was 41.7%, at grade1-3 was 62.5%, only 1 case at grade 0 and it occured.Conclusion①DSC-PWI is the effective method to evaluate the CCD②The size of cerebral infarction volume is positive correlation with CCD③It is more likely occurance in the patients with grade 1-3 than upper grade 3... |
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