R M Polan1, A Poretti1, T A G M Huisman1, T Bosemani2. 1. From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland. tbosema1@jhmi.edu.
Abstract
BACKGROUND AND PURPOSE: SWI provides information about blood oxygenation levels in intracranial vessels. Prior reports have shown that SWI focusing on venous drainage can provide noninvasive information about the degree of brain perfusion in pediatric arterial ischemic stroke. We aimed to evaluate the influence of the SWI venous signal pattern in predicting stroke evolution and the development of malignant edema in a large cohort of children with arterial ischemic stroke. MATERIALS AND METHODS: A semiquantitative analysis of venous signal intensity on SWI and diffusion characteristics on DTI was performed in 16 vascular territories. The mismatch between areas with SWI-hypointense venous signal and restricted diffusion was correlated with stroke progression on follow-up. SWI-hyperintense signal was correlated with the development of malignant edema. RESULTS: We included 24 children with a confirmed diagnosis of pediatric arterial ischemic stroke. Follow-up images were available for 14/24 children. MCA stroke progression on follow-up was observed in 5/6 children, with 2/8 children without mismatch between areas of initial SWI hypointense venous signal and areas of restricted diffusion on DTI. This mismatch showed a statistically significant association (P = .03) for infarct progression. Postischemic malignant edema developed in 2/10 children with and 0/14 children without SWI-hyperintense venous signal on initial SWI (P = .07). CONCLUSIONS: SWI-DTI mismatch predicts stroke progression in pediatric arterial ischemic stroke. SWI-hyperintense signal is not useful for predicting the development of malignant edema. SWI should be routinely added to the neuroimaging diagnostic protocol of pediatric arterial ischemic stroke.
BACKGROUND AND PURPOSE: SWI provides information about blood oxygenation levels in intracranial vessels. Prior reports have shown that SWI focusing on venous drainage can provide noninvasive information about the degree of brain perfusion in pediatric arterial ischemic stroke. We aimed to evaluate the influence of the SWI venous signal pattern in predicting stroke evolution and the development of malignant edema in a large cohort of children with arterial ischemic stroke. MATERIALS AND METHODS: A semiquantitative analysis of venous signal intensity on SWI and diffusion characteristics on DTI was performed in 16 vascular territories. The mismatch between areas with SWI-hypointense venous signal and restricted diffusion was correlated with stroke progression on follow-up. SWI-hyperintense signal was correlated with the development of malignant edema. RESULTS: We included 24 children with a confirmed diagnosis of pediatric arterial ischemic stroke. Follow-up images were available for 14/24 children. MCA stroke progression on follow-up was observed in 5/6 children, with 2/8 children without mismatch between areas of initial SWI hypointense venous signal and areas of restricted diffusion on DTI. This mismatch showed a statistically significant association (P = .03) for infarct progression. Postischemic malignant edema developed in 2/10 children with and 0/14 children without SWI-hyperintense venous signal on initial SWI (P = .07). CONCLUSIONS: SWI-DTI mismatch predicts stroke progression in pediatric arterial ischemic stroke. SWI-hyperintense signal is not useful for predicting the development of malignant edema. SWI should be routinely added to the neuroimaging diagnostic protocol of pediatric arterial ischemic stroke.
Authors: J H Pexman; P A Barber; M D Hill; R J Sevick; A M Demchuk; M E Hudon; W Y Hu; A M Buchan Journal: AJNR Am J Neuroradiol Date: 2001-09 Impact factor: 3.825
Authors: J C Baron; D Rougemont; F Soussaline; P Bustany; C Crouzel; M G Bousser; D Comar Journal: J Cereb Blood Flow Metab Date: 1984-06 Impact factor: 6.200
Authors: Paul Monagle; Elizabeth Chalmers; Anthony Chan; Gabrielle deVeber; Fenella Kirkham; Patricia Massicotte; Alan D Michelson Journal: Chest Date: 2008-06 Impact factor: 9.410
Authors: Ralph Rahme; Lincoln Jimenez; Umair Bashir; Opeolu M Adeoye; Todd A Abruzzo; Andrew J Ringer; Brett M Kissela; Jane Khoury; Charles J Moomaw; Heidi Sucharew; Simona Ferioli; Matthew L Flaherty; Daniel Woo; Pooja Khatri; Kathleen Alwell; Dawn Kleindorfer Journal: Childs Nerv Syst Date: 2012-08-23 Impact factor: 1.475
Authors: Timothy J Bernard; Michael J Rivkin; Kelley Scholz; Gabrielle deVeber; Adam Kirton; Joan Cox Gill; Anthony K Chan; Collin A Hovinga; Rebecca N Ichord; James C Grotta; Lori C Jordan; Susan Benedict; Neil R Friedman; Michael M Dowling; Jorina Elbers; Marcela Torres; Sally Sultan; Dana D Cummings; Eric F Grabowski; Hugh J McMillan; Lauren A Beslow; Catherine Amlie-Lefond Journal: Stroke Date: 2014-06-10 Impact factor: 7.914
Authors: Charlie Chia-Tsong Hsu; Gigi Nga Chi Kwan; Sachintha Hapugoda; Michelle Craigie; Trevor William Watkins; E Mark Haacke Journal: Neuroradiol J Date: 2017-01-01
Authors: Salil Soman; Jose A Bregni; Berkin Bilgic; Ursula Nemec; Audrey Fan; Zhe Liu; Robert L Barry; Jiang Du; Keith Main; Jerome Yesavage; Maheen M Adamson; Michael Moseley; Yi Wang Journal: Curr Radiol Rep Date: 2017-02-14
Authors: Adam M Winchell; Ruitian Song; Ralf B Loeffler; Winfred C Wang; Jane S Hankins; Kathleen J Helton; Claudia M Hillenbrand Journal: J Healthc Eng Date: 2017-08-28 Impact factor: 2.682