Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-19T13:07:02.657Z Has data issue: false hasContentIssue false

Chapter 51 - Physiological MR imaging techniques and pediatric stroke

from Section 8 - Pediatrics

Published online by Cambridge University Press:  05 March 2013

By
Dawn Saunders ,
W. Kling Chong  and
Vijeya Ganesan
Edited by
Jonathan H. Gillard ,
Adam D. Waldman  and
Peter B. Barker
Jonathan H. Gillard
Affiliation:
University of Cambridge
Adam D. Waldman
Affiliation:
Imperial College London
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Get access

Summary

Introduction

Stroke is an important and under-recognized disorder in children and is one of the top 10 causes of childhood death.[1] Arterial ischemic stroke affects around 8 of 100 000 children annually. Up to a quarter of these children will have a recurrence and two-thirds have long-term disability directly attributable to stroke.[2] Many advances in the understanding of childhood stroke have arisen from the insights available from modern imaging techniques, in particular from MR imaging (MRI). The aims of conventional MRI are not only to detect the infarct but also to provide information to establish the cause of the stroke and to exclude other causes (such as tumor). Clinical applications of physiological MRI techniques (MR diffusion imaging [DWI], MR perfusion imaging, and MR spectroscopy [MRS]) in this group of patients are still largely in the research domain. This chapter will consider arterial ischemic stroke (henceforth abbreviated as stroke) in children over 1 month of age.

There are some important differences in stroke etiology between adults and children. Around half of the children affected by stroke will have another recognized medical condition, most commonly sickle cell disease (SCD) or congenital heart disease. Consequently, many children may have dual pathologies on imaging, as well as factors that may influence the interpretation of physiological MRI (e.g., chronic hypoxia or polycythemia). Rather than having a single identified etiology, the majority of children with stroke will have a combination of multiple risk factors. As well as those already mentioned, other important risk factors for stroke in children are anemia (which is found in up to 40%), prothrombotic disorders, and infections such as varicella zoster virus.[3]

Type
Chapter
Information
Clinical MR Neuroimaging
Physiological and Functional Techniques
 , pp. 784 - 805
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fullerton, HJ.Chetkovich, DM, Wu, YW, et al. Deaths from stroke in US children, 1979 to 1998. Neurology 2002; 59: 34–39.CrossRefGoogle ScholarPubMed
Ganesan, V, Hogan, A, Jones, A, Shack, N, Kirkham, FJ. Parent-reported outcome in ischaemic stroke. Dev Med Child Neurol 2000; 42: 455–461.CrossRefGoogle Scholar
Ganesan, V, Prengler, M, McShane, MA, Wade, A, Kirkham, FJ.Investigation of risk factors in children with arterial ischaemic stroke. Ann Neurol 2003; 53: 167–173.CrossRefGoogle Scholar
Sébire, G, Fullerton, H, Riou, E, deVeber, G.Toward the definition of cerebral arteriopathies of childhood. Curr Opin Pediatr 2004; 16: 617–622.CrossRefGoogle ScholarPubMed
Fullerton, HJ, Wu, YW, Sidney, S, Johnston, SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics 2007; 119: 495–501.CrossRefGoogle Scholar
Danchaivijitr, N, Miravet, E, Saunders, DE, Cox, T, Ganesan, V. Post varicella intracranial haemorrhage in a child. Devel Med Child Neurol 2006; 48: 139–142.CrossRefGoogle Scholar
Sury, MRJ, Hatch, DJ, Deeley, T, Dick-Mireaux, C, Chong, WK. Development of a nurse-led sedation service for paediatric magnetic resonance imaging. Lancet 1999; 353: 1667–1671.CrossRefGoogle ScholarPubMed
Barkovich, AJ, Kjos, BO, Jackson, DE, Norman, D. Normal brain maturation of the neonatal and infant brain: MR imaging at 1.5 T. Radiology 1998; 166: 173–180.CrossRefGoogle Scholar
Chiron, C, Raynaud, C, Mazière, B, et al. Changes in regional cerebral blood flow during brain maturation in children and adolescents. J Nucl Med 1992; 33: 696–703.Google ScholarPubMed
Chugani, HT, Phelps, ME, Mazziotta, JC. Positron emission tomography of human brain functional development. Ann Neurol 1987; 22: 487–497.CrossRefGoogle ScholarPubMed
Scott, RC, Gadian, DG, Cross, JH, et al. Quantitative magnetic resonance characterization of mesial temporal sclerosis in childhood. Neurology 2001; 56: 1659–1665.CrossRefGoogle ScholarPubMed
Forbes, KPN, Pipe, JG, Bird CR. Changes in brain water during the first year of life. Radiology 2002; 222: 405–409.CrossRefGoogle Scholar
Mukherjee, P, Miller, JH, Shimony, JS, et al. Normal brain maturation during childhood: developmental trends characterized with diffusion-tensor MR imaging. Radiology 2001; 221: 349–358.CrossRefGoogle ScholarPubMed
Kreis, R, Ernst, T, Ross, BD. Development of human brain: in vivo quantification of metabolite and water content with proton magnetic resonance spectroscopy. Mag Reson Med 1993; 30: 424–437.CrossRefGoogle ScholarPubMed
Pouwels, PJW, Brockmann, K, Kruse, B, et al. Regional dependence of human brain metabolites from infancy to adulthood as detected by quantitative localised proton MRS. Paediatr Res 1999; 46: 474–485.CrossRefGoogle Scholar
Moseley, ME, Cohen, Y, Mintorovitch, J, et al. Early detection of regional cerebral ischaemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy. Magn Reson Med 1990; 14: 330–346.CrossRefGoogle ScholarPubMed
Pierpaoli, C, Jezzard, P, Basser, PJ, Barnett, A, Di Chiro, G.Diffusion tensor MR imaging of the human brain. Radiology 1996; 201: 637–648.CrossRefGoogle ScholarPubMed
Morriss, MC, Zimmerman, RA, Bilaniuk, LT, Hunter, JV, Haselgrove, JC. Changes in brain water diffusion during childhood. Neuroradiology 1999; 41: 929–934.CrossRefGoogle ScholarPubMed
Englebrecht, V, Scherer, A, Rassek, M, Wittsack, HJ, Modder, U. Diffusion-weighted MR imaging of the paediatric brain: findings in normal brain and white matter disease. Radiology 2002; 222: 410–418.CrossRefGoogle Scholar
Neil, JJ, Shiran, SI, McKinstry, RC, et al. Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging. Radiology 1998; 209: 57–66.CrossRefGoogle ScholarPubMed
Wimberger, DM, Roberts, TP, Barkovich, AJ, et al. Identification of “premyelination” by diffusion-weighted MRI. J Comput Assist Tomogr 1995; 19: 28–33.CrossRefGoogle ScholarPubMed
Beaulieu, C, Allen, PS. Determinants of anisotrophic water diffusion in nerves. Magn Reson Med 1994; 31: 394–400.CrossRefGoogle Scholar
Hüppi, P, Maier, S, Pelad, S, et al. Microstructural development of human newborn cerebral white matter assessed in vivo diffusion tensor magnetic resonance imaging. Pediatr Res 1998; 44: 584–590.CrossRefGoogle ScholarPubMed
Mori, S, Itoh, R, Zhang, J, et al. Diffusion tensor imaging of the developing mouse brain. Mag Reson Med 2001; 46: 18–23.CrossRefGoogle ScholarPubMed
Schneider, JFL, Il’yasov, KA, Hennig, J, Martin, E. Fast quantitative diffusion-tensor imaging of cerebral white matter from the neonatal period to adolescence. Neuroradiology 2004; 46: 258–266.CrossRefGoogle Scholar
Qiua, D, Tan, LH, Zhou, K, Khong, PL. Diffusion tensor imaging of normal white matter maturation from late childhood to young adulthood: voxel-wise evaluation of mean diffusivity, fractional anisotropy, radial and axial diffusivities, and correlation with reading development. Neuroimage 2008; 41: 223–232.CrossRefGoogle Scholar
Perthen, JE, Calamante, F, Gadian, DG, Connelly, A. A novel pulsed arterial spin labeling sequence to allow the investigation of transit times. In Proceedings of the 11th Annual Meeting of the International Society of Magnetic Resonance in Medicine, Toronto, 2003, p. 2211.Google Scholar
Wang, J, Licht, DJ, Liu, C, et al. Pediatric perfusion imaging using arterial spin labelling. In Proceedings of the 11th Annual Meeting of the International Society of Magnetic Resonance in Medicine, Toronto, 2003, p. 121.Google Scholar
Biagi, L, Abbruzzese, A, Bianchi, MC et al. Age dependence of cerebral perfusion assessed by magnetic resonance continuous arterial spin labelling. J Mag Reson Imaging 2007; 25: 696–702.CrossRefGoogle Scholar
Newell, DW, Aaskid, R. Transcranial Doppler: clinical and experimental uses. Cerebrovasc Brain Metab Rev 1992; 4: 122–143.Google ScholarPubMed
Huttenlocher, PR, Dabholkar, AS. Regional differences in synaptogenesis in human cerebral cortex. J Comp Neurol 1997; 387: 167–178.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Provenzale, JR, Engelter, ST, Petrells, JR, Smith, JS, MacFall, JR. Use of exponential diffusion-weighted images to eradicate T2 shine-through effect. Am J Roentgenol 1999; 172: 537–539.CrossRefGoogle ScholarPubMed
Saunders, DE, Bynevelt, M, Hewes, DKM, et al. MRI in children with sickle cell disease without overt stroke. Dev Med Child Neurol 2002; 42(Suppl 90): 27.Google Scholar
Lo, EH, Matsumoto, K, Pierce, AR, Garrido, L, Luttinger, D. Pharmacological reversal of acute changes in diffusion-weighted magnetic resonance imaging in focal cerebral ischaemia. J Cereb Blood Flow Metab 1994; 14: 597–603.CrossRefGoogle Scholar
Minematsu, K, Li, L, Sotak, CH, Davis, MA, Fischer, M. Reversible focal ischaemic injury demonstrated by diffusion-weighted magnetic resonance imaging in rats. Stroke 1992; 23: 1304–1310.CrossRefGoogle ScholarPubMed
Connelly, A, Chong, WK, Johnson, CL, et al. Diffusion-weighted magnetic resonance imaging of compromised tissue in stroke. Arch Dis Child 1997; 77: 38–41.CrossRefGoogle ScholarPubMed
Grant, PE, He, J, Halpern, EF, et al. Frequency and clinical context of decreased apparent diffusion coefficient reversal in the human brain. Radiology 2001; 221: 43–50.CrossRefGoogle ScholarPubMed
Coley, SC, Porter, DA, Calamante, F, Chong, WK, Connelly, A. Quantitative MR diffusion mapping and cyclosporine-induced neurotoxicity. AJNR Am J Neuroradiol 1999; 20: 1507–1510.Google ScholarPubMed
Hinchey, J, Chaves, C, Appigani, B, et al. A reversible posterior leukoencephalopathy syndrome. New Engl J Med 1996; 334: 494–500.CrossRefGoogle ScholarPubMed
Edwards, MJ, Walker, R, Vinnicombe, S, et al. Reversible posterior leukoencephalopathy syndrome following CHOP chemotherapy for diffuse large B-cell lymphoma. Ann Oncol 2001; 12: 1327–1329.CrossRefGoogle ScholarPubMed
Shin, RK, Stern, JW, Janss, AJ, Hunter, JV, Liu, GT. Reversible posterior leukoencephalopathy during treatment for acute lymphoblastic leukaemia. Neurology 2001; 56: 388–391.CrossRefGoogle Scholar
Tournier, JD, Rowan, A, Calamante, F, et al. Changes in gray and white matter structures associated with language in patients with acquired unilateral basal ganglia infarction revealed by structural and diffusion tensor MRI. In Proceedings of the 11th Annual Meeting of the International Society of Magnetic Resonance in Medicine, Toronto, 2003, p. 401.Google Scholar
Khong, PL, Zhou, LJ, Ooi, GC, et al. The evaluation of Wallerian degeneration in chronic paediatric middle cerebral artery infarction using diffusion tensor MR imaging. Cerebrovasc Dis 2004; 18: 240–247.CrossRefGoogle ScholarPubMed
Kirkham, FJ, Calamante, F, Bynevelt, M, et al. Perfusion magnetic resonance abnormalities in patients with sickle cell disease. Ann Neurol 2001; 49: 477–485.CrossRefGoogle ScholarPubMed
Calamante, F, Gadian, DG, Connelly, A.Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use. Stroke 2002; 33: 1146–1151.CrossRefGoogle ScholarPubMed
Oguz, KK, Golay, X, Pizzini, FB, et al. Sickle cell disease: continuous arterial spin-labelling perfusion MR imaging in children. Radiology 2003; 227: 567–574.CrossRefGoogle Scholar
Tsuchiya, K, Inaoka, S, Mizutani, Y, Hachiya, J. Echo-planar perfusion MR of moyamoya disease. AJNR Am J Neuroradiol 1998; 19: 211–216.Google ScholarPubMed
Calamante, F, Ganesan, V, Kirkham, FJ, et al. MR perfusion imaging in moyamoya syndrome: potential implications for clinical evaluation of occlusive cerebrovascular disease. Stroke 2001; 32: 2810–2816.CrossRefGoogle ScholarPubMed
Lee, S-K, Kim, DI, Jeong, E-K, et al. Postoperative evaluation of moyamoya disease with perfusion-weighted MR imaging: initial experience. AJNR Am J Neuroradiol 2003; 24: 741–747.Google ScholarPubMed
Wityk, RJ, Hillis, A, Beauchamp, N, Barker, PB, Rigamonti, D. Perfusion-weighted magnetic resonance imaging in adult moyamoya syndrome: characteristic patterns and change after surgical intervention: case report. Neurosurgery 2002; 51: 1499–1506.CrossRefGoogle ScholarPubMed
Wang, Z, Bogdan, AR, Zimmerman, RA, et al. Investigation of stroke in sickle cell disease by 1H nuclear magnetic resonance spectroscopy. Neuroradiology 1992; 35: 57–65.CrossRefGoogle ScholarPubMed
Kohli, A, Gupta, R, Kishore, J. Anterior cerebral artery territory infarction in neurocysticercosis: evaluation by MR angiography and in vivo proton MR spectroscopy. Pediatr Neurosurg 1997; 26: 93–96.CrossRefGoogle ScholarPubMed
Saunders, DE, Howe, FA, van den Boogaart, A, et al. Continuing ischemic damage following acute middle cerebral artery infarction in man demonstrated by short echo proton spectroscopy. Stroke 1995; 26: 1007–1013.CrossRefGoogle Scholar
Wilichowski, E, Pouwels, PJW, Frahm, J, Hanefeld, F. Quantitative proton magnetic resonance spectroscopy of cerebral metabolic disturbances in patients with MELAS. Neuropaediatrics 1999; 30: 256–263.CrossRefGoogle ScholarPubMed
Birken, DL, Oldendorf, WH. N-Acetyl-l-aspartic acid: a literature review of a compound prominent in 1H-MRS spectroscopic studies of brain. Neurosci Biobehav Rev 1989; 13: 23–31.CrossRefGoogle ScholarPubMed
Hunter, JV, Wang, ZJ.MR spectroscopy in paediatric neuroradiology. MRI Clin N Am 2001; 9: 165–189.Google Scholar
Graham, GD, Blamire, AM, Rothman, DL, et al. Early temporal variation of cerebral metabolites after human stroke. A proton magnetic resonance study. Stroke 1993; 24: 1891–1896.CrossRefGoogle Scholar
DeStafano, N, Matthews, PM, Arnold, DL. Reversible decreases in N-acetylaspartate after acute brain injury. Mag Reson Med 1995; 34: 721–727.Google Scholar
Arnold, DL, Mathews, VP, Francis, GS, O’Connor, J, Antel, JP. Proton magnetic resonance spectroscopic imaging for metabolic characterization of demyelinating plaques. Ann Neurol 1992; 31: 235–241.CrossRefGoogle ScholarPubMed
Davie, CA, Hawkins, CP, Barker, GJ, et al. Serial proton magnetic resonance spectroscopy in acute multiple sclerosis lesions. Brain 1994; 117: 49–58.CrossRefGoogle ScholarPubMed
Vion-Dury, J, Nicoli, F, Salvan, AM, et al. Reversal of brain metabolic alterations with zidovudine detected by proton localised magnetic resonance spectroscopy. Lancet 1995; 345: 60–61.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×