Neuroimaging Advances in Pediatric Stroke

Manus J. Donahue, PhD; Nomazulu Dlamini, MD, PhD; Aashim Bhatia, MD, MS; Lori C. Jordan, MD, PhD

Stroke. 2019;50(2):240-248.

Abstract and Introduction

Introduction

When a child has stroke-like symptoms, critical issues must be addressed, including confirmation of stroke rather than a stroke mimic, stroke pathogenesis, pathophysiology of the injury, and evaluation of recovery potential. During the next decade, technological advances will enable improved monitoring and personalized therapy in multiple stages of cerebrovascular disease, including stroke prevention, acute stroke, and poststroke rehabilitation. Neuroimaging will likely play a central role in each area, and the emphasis of new neuroimaging avenues will not only focus on mapping the topography of prior tissue damage but expand to include molecular and hemodynamic biomarkers that may be used to triage patients for preventative therapies and optimize these therapies by quantifying their impact on tissue function and health.

Computed tomographic (CT) perfusion, positron emission tomography, and magnetic resonance imaging (MRI) are relevant for characterizing functional tissue profiles; however, MRI is particularly appealing in pediatric patients because of the ability to sequentially visualize soft tissue, vasculature, and quantitative hemometabolic markers of ischemia without ionizing radiation. This review focuses on clinical questions that may be answered with advanced neuroimaging in children with suspected stroke and highlights how quantitative, noninvasive imaging may be used to expand the pediatric stroke imaging landscape.

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Cite this: Neuroimaging Advances in Pediatric Stroke - Medscape - Feb 01, 2019.

Table. Emerging Magnetic Resonance Imaging Methods
Method	Measurement	Relevance	Coverage (Voxel Dimensions)	Current Limitations	Duration, min
ASL	CBF	Acute stroke penumbra and tissue function	Regional quantitative CBF with 2D or 3D whole-brain coverage (3–5 mm)	Quantitative interpretation in patients with vasculopathy because of variable labeling and long blood arrival times	2–5
APT	pH/acidosis	Acute stroke penumbra	Regional qualitative molecular information provided with 3D whole-brain coverage (2–7 mm)	Long whole-brain scan times for acute stroke imaging. No consensus on quantification	4–12
Vessel wall imaging	Vessel wall, lumen thickness, enhancement	Vasculitis, arteriopathy, dissection, atherosclerosis	Major cervical and intracranial vessels (0.6–0.8 mm)	CSF suppression; spatial resolution for intracranial vessel walls	4–11
BOLD reactivity	CVR	Cerebrovascular reserve capacity/stroke risk	Regional qualitative information with 2D whole-brain coverage (2–4 mm)	Nonquantitative in most implementations	5–12
T2-relaxation-under-spin-tagging	OEF	Balance of oxygen consumed and delivered, stroke risk	Global quantitative OEF measurement (2–4 mm)	Global OEF measure only	1–2
Asymmetrical spin echo	OEF	Regional balance of oxygen consumed and delivered	Regional quantitative OEF with whole-brain coverage (2–4 mm)	Complex postprocessing required. No consensus on quantification	3–10
Edited spectroscopy	GABA	Excitation/inhibition imbalance: plasticity	Single voxel (20–40 mm)	Limited spatial coverage and macromolecule contamination	5–10

2D indicates 2 dimensional; 3D, 3 dimensional; APT, amide proton transfer; ASL, arterial spin labeling; BOLD, blood oxygenation level dependent; CBF, cerebral blood flow; CSF, cerebrospinal fluid; CVR, cerebrovascular reactivity; GABA, γ-aminobutyric acid; and OEF, oxygen extraction fraction.

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Neuroimaging Advances in Pediatric Stroke

Abstract and Introduction

Introduction

Tables

References

Authors and Disclosures

Authors and Disclosures

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