Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Int J Stroke. 2016 Dec;11(9):1028-1035. doi: 10.1177/1747493016666089. Epub 2016 Aug 22.
Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome.
AIM/HYPOTHESIS: We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome.
This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5-14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging (b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann-Whitney test).
Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes (p = 0.03). Corticospinal tract diaschisis was associated with motor outcome (p = 0.004). Method reliability was excellent.
Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.
弥散加权成像磁共振成像可能检测到与神经病理学描述的隔室现象相一致的与中风相关的脑结构远程变化。早期弥散加权成像显示，所有年龄段的动脉性缺血性中风后皮质脊髓束通路受限，与运动结局相关。
目的/假设：我们假设在儿童动脉性缺血性中风中可以测量到脑隔室现象，并探讨了与结果的相关性。
本研究是对儿科 NIH 中风量表研究的验证，前瞻性纳入了急性动脉性缺血性中风的儿童，并进行了急性和早期随访（5-14 天）弥散加权成像。纳入标准为：（1）单侧大脑中动脉动脉性缺血性中风；（2）急性和亚急性弥散加权成像（b=1000）；（3）12 个月的神经学随访（小儿中风结局测量）。使用 ImageJ 软件的一种经过验证的方法对解剖学上相连结构的弥散加权成像隔室现象进行了量化。对弥散加权成像隔室现象进行了校正，以与梗死体积、年龄、成像时间和结果（卡方/Fisher、Mann-Whitney 检验）进行比较。
19 名儿童（53%为男性，中位数 8.1 岁）在中风发病后中位数为 21 小时和 168 小时进行了磁共振成像。隔室现象很常见，并随时间演变，在急性弥散加权成像中发现 1 例（5%），在随访弥散加权成像中发现 8 例（42%）。丘脑和胼胝体隔室现象最为常见（5 例，26%）。病变周围隔室现象的估计值各不相同（梗死体积的 54±18%）。有隔室现象的儿童往往更年轻（7.02±5.4 岁与 11.82±4.3 岁，p=0.08）。总隔室现象评分与认知结局不良相关（p=0.03）。皮质脊髓束隔室现象与运动结局相关（p=0.004）。方法可靠性很好。
弥散加权成像的隔室现象发生在儿童动脉性缺血性中风中。将隔室现象误认为是新的梗死区具有重要的临床意义。需要进一步的认识和研究来确定其临床相关性。
