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Quantitative Longitudinal Evaluation of Diaschisis-Related Cerebellar Perfusion and Diffusion Parameters in Patients with Supratentorial Hemispheric High-Grade Gliomas After Surgery

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Abstract

Decreased cerebral blood volume (CBV) in contralateral cerebellar gray matter (cGM) in conjunction with cerebellar white matter (cWM) damage, consistent with crossed cerebro-cerebellar diaschisis (cCCD) develop following supratentorial hemispheric stroke. In this study, we investigated the longitudinal evolution of diaschisis-related cerebellar perfusion and diffusion tensor-imaging (DTI) changes in patients after surgery for supratentorial brain tumors. Eight patients (M:F 5:3, age 8–22 years) who received surgery for supratentorial high-grade gliomas were evaluated. Initial MRI studies were performed 19–54 days postoperatively, with follow-ups at 2- to 3-month intervals. For each study, parametric maps of the cerebellum were generated and coregistered to T1-weighted images that had been previously segmented for cGM and cWM. Aggregate mean values of CBV, cerebral blood flow (CBF), and fractional anisotropy (FA) were obtained separately for cGM and cWM, and asymmetry indices (AIs) were calculated. Hemodynamic changes were more robust in cGM than in cWM. Seven patients showed decreased perfusion within cGM contralateral to the supratentorial lesion on the first postoperative study, and asymmetry was significant for both CBV (p = 0.008) and CBF (p < 0.01). For CBV, follow-up studies showed a significant trend towards recovery (p < 0.02). DTI changes were more pronounced in cWM. FA values suggested a “paradoxical” increase at initial follow-up, but steadily declined thereafter (p = 0.0003), without evidence of subsequent recovery. Diaschisis-related hemodynamic alterations within cGM appear on early postoperative studies, but CBV recovers over time. Conversely, cWM DTI changes are delayed and progressive. Although the clinical correlates of cCCD are yet to be elucidated, better understanding of longitudinal structural and hemodynamic changes within brain remote from the area of primary insult could have implications in research and clinical rehabilitative strategies.

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Acknowledgments

The authors thank Cherise M. Guess for reviewing and editing the manuscript.

Conflict of Interest

AB received partial financial support for this research from OSI Pharmaceuticals and Genentech ZP, CP, YL, MS, AB, and RJO received partial support from the US National Institutes of Health Cancer Center Support (CORE) Grant P30 CA21765 and the American Lebanese Syrian Associated Charities (ALSAC) while conducting this research.

The other authors declare no conflict of interest with regard to the subject matter presented in this manuscript.

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Authors and Affiliations

  1. Section of Neuroimaging, Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Zoltan Patay

  2. Division of Translational Imaging Research, Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Carlos Parra, Matthew Scoggins & Robert J. Ogg

  3. Diagnostic Neuroradiology, Department of Radiology, Medical University of South Carolina, MSC 322, 169 Ashley Avenue, Charleston, SC, 29425, USA

    Harris Hawk

  4. Department of Anesthesiology and Critical Care, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, 411018, India

    Arun George

  5. Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Yimei Li

  6. Division of Neuro-Oncology, Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Alberto Broniscer

  7. Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38105-3678, USA

    Zoltan Patay

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  1. Zoltan Patay
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  2. Carlos Parra
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  3. Harris Hawk
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  4. Arun George
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  7. Alberto Broniscer
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  8. Robert J. Ogg
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Correspondence to Zoltan Patay.

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Patay, Z., Parra, C., Hawk, H. et al. Quantitative Longitudinal Evaluation of Diaschisis-Related Cerebellar Perfusion and Diffusion Parameters in Patients with Supratentorial Hemispheric High-Grade Gliomas After Surgery. Cerebellum 13, 580–587 (2014). https://doi.org/10.1007/s12311-014-0575-2

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  • DOI: https://doi.org/10.1007/s12311-014-0575-2

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