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Review
. 2019 Feb;50(2):240-248.
doi: 10.1161/STROKEAHA.118.020478.

Neuroimaging Advances in Pediatric Stroke

Manus J Donahue  1 , Nomazulu Dlamini  2 , Aashim Bhatia  1 , Lori C Jordan  3
Affiliations
Review

Neuroimaging Advances in Pediatric Stroke

Manus J Donahue et al. Stroke. 2019 Feb.
No abstract available

Keywords: biomarkers; child; humans; neuroimaging; stroke; triage.

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Figures

Figure 1.
Figure 1.
(A) In ASL-MRI, blood water is magnetically labeled using a single (pulsed or continuous) or series of (pseudo-continuous) radiofrequency pulses, after which the inverted blood water flows into the capillary exchange site of the imaging slice, exchanges with tissue water, and attenuates the extravascular water signal. By comparing this image with an image in which blood water is unlabeled, a perfusion-weighted map is obtained. (B) Time-of-flight MRA of a patient with moyamoya and left supraclinoid ICA occlusion, focal stenosis of distal right ICA, and bilateral MCA occlusion. (C) ASL-MRI before and after bilateral encephaloduroarteriosynangiosis (22 months post-left; 16 months post-right) shows improved CBF post-surgery.
Figure 2.
Figure 2.
(A) APT-CEST MRI exploits the fact that amide protons, which resonance at +3.5 ppm from water, are in exchange with surrounding water protons. (B) The exchange rate is base-catalyzed over a physiological range, with more acidic environments yielding lower exchange. (C) When off-resonance pre-pulses are applied at the amide resonance prior to water excitation and detection, proton exchange will lead to an attenuation of the water signal. (D) An acute stroke patient with MCA occlusion subsequently treated with mechanical thrombectomy. There is an extensive penumbra and area with decreased APT effect on the acute MRI 2–4 hours post-symptom onset. The APT map by convention shows [1-Signal after saturation] (more acidic environment dark); a positive acute APT lesion is more similar to the FLAIR lesion on 30-day follow-up than the acute ADC or TTP map. More information in Titze et al.
Figure 3.
Figure 3.
(A) Vessel wall contrast patterns. (B) Post-varicella transient cerebral arteriopathy shows acute infarct of the left internal capsule and narrowing of the terminal left ICA, MCA, and ACA on MRA; post-contrast VWI shows concentric wall enhancement (arrow; right panel). (C) Vertebral artery pseudoaneurysm. T2-weighted imaging at presentation shows a chronic thalamic infarct (arrow). Catheter angiography shows luminal irregularity. Vessel wall imaging shows wall thickening and concentric enhancement (arrow; right panel). (D) Takayasu Arteritis. Post-ferumoxytol (iron-based intravascular contrast agent) angiography depicts the asymmetric smaller caliber of the left CCA (arrow), secondary to vessel wall thickening. Pre-contrast vessel wall imaging demonstrates circumferential wall thickening of the left CCA (arrow). Post-contrast imaging demonstrates enhancement (arrow) of the left CCA vessel wall indicating active inflammation. (B,C) images adapted from Dlamini et al.
Figure 4.
Figure 4.
(A) 7.0T vessel wall imaging shows intracranial vessel wall segments (white arrows) and a basilar artery lesion (black arrow). (B) T1-weighted imaging acquired at 3.0T (1 mm) and 7.0T (0.7 mm) in the same volunteer for common scan-duration=5 minutes. (C) 7.0T ASL acquired at different post-labeling delays demonstrates potential for quantifying CBF at very long arterial arrival times (3000–4000ms), which are common in stroke. Images shown are from an adult.
See this image and copyright information in PMC

References

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