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Normal intracranial periarterial enhancement on pediatric brain MR imaging
Aleksandra Mineyko1, Adam Kirton, Danny Ng
1Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Insights
Normal periarterial enhancement is common in children
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Vascular Imaging
Background:
- Childhood stroke is often caused by large/medium vessel vasculitis.
- Postcontrast MRI vessel wall enhancement may indicate intracranial vasculitis.
- Normal periarterial enhancement patterns in children are not well-described.
Purpose of the Study:
- To systematically describe normal periarterial enhancement in the pediatric population.
- Establish a baseline for interpreting MRI scans in children with suspected vasculitis.
Main Methods:
- Retrospective review of MR scans from 2007-2010 in children with normal brain parenchyma and no clinical concern for vasculopathy.
- Inclusion of axial and coronal postcontrast fat-saturated T1-weighted images (3-mm slice thickness).
- Two investigators graded periarterial enhancement intensity on a three-point scale for intracranial arteries.
Main Results:
- 44 pediatric patients (4 months to 16 years) were analyzed.
- High inter- and intra-rater reliability (kappa >0.65) for enhancement grading.
- Common findings included thin, linear, symmetrical enhancement, most prominent in the internal carotid and middle cerebral arteries; rare around CSF-bordered segments.
Conclusions:
- Normal periarterial enhancement is frequently observed and typically symmetrical in major pediatric intracranial arteries.
- Enhancement is less common around arterial segments adjacent to cerebrospinal fluid (CSF).
- Understanding these normal findings aids in sensitive and specific MRI interpretation for pediatric vasculitis.
Introduction:
Large/medium vessel vasculitis is an important etiology of childhood stroke. Early research suggests vessel wall enhancement on postcontrast MRI may be a marker of intracranial vasculitis yet no systematic descriptions of normal periarterial enhancement exist in the literature. The aim was to describe normal periarterial enhancement in the pediatric population.
Methods:
We included all children who had an MR scan between January 2007 and December 2010, with normal parenchymal imaging, no clinical concern of vasculopathy, and axial and coronal postcontrast fat-saturated T1-weighted images with 3-mm slice thickness. Intensity of periarterial enhancement was graded on a three-point scale by two investigators for all intracranial large and medium arteries.
Results:
A total of 44 patients aged 4 months to 16 years were included. Inter- and intra-rater reliability in enhancement grading was high (all kappa >0.65). Thin, linear, noncircumferential periarterial enhancement was common and usually symmetrical. It was most commonly prominent in the cavernous and petrous segments of the internal carotid artery and the M1 segment of the middle cerebral artery. Periarterial enhancement was rarely observed at segments surrounded by CSF, including supraclinoid segments of the internal carotid arteries, P1 segments of the posterior cerebral arteries, V4 segments of the vertebral artery, and the basilar arteries.
Conclusion:
Normal periarterial enhancement is common and usually symmetrical along major intracranial arteries but rarely seen around arterial segments bordered by CSF. Knowledge of these findings may be useful for a sensitive and specific interpretation of MR scans of patients with clinical concerns of vasculitis.
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