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Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats
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Paradoxical centrally increased diffusivity in perinatal arterial ischemic stroke.

Nicholas V Stence1,2, David M Mirsky3,4, Sean C L Deoni3,4

  • 1Department of Radiology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA. nicholas.stence@childrenscolorado.org.

Pediatric Radiology
|August 5, 2015
PubMed
Summary

Centrally increased diffusivity on MRI in perinatal arterial ischemic stroke indicates larger infarcts and irreversible tissue injury. This finding is crucial for accurate diagnosis and management of pediatric stroke.

Keywords:
Cerebral infarctionDiffusion-weighted imagingMagnetic resonance imagingNeonatePerinatal arterial ischemic stroke

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Area of Science:

  • Pediatric neurology
  • Neuroradiology
  • Neuroscience

Background:

  • Acute MRI with restricted diffusion is standard for perinatal arterial ischemic stroke (PAIS).
  • A subset of PAIS cases shows central increased diffusivity with peripheral restricted diffusion, particularly with large infarcts.

Purpose of the Study:

  • To determine the significance of centrally increased diffusivity in PAIS.
  • To test the hypothesis that this appearance correlates with larger infarcts and irreversible tissue injury.

Main Methods:

  • Retrospective review of PAIS cases from a prospective cohort (2000-2012).
  • Infarct volume measurement using diffusion-weighted imaging (DWI) regions of interest.
  • Statistical comparison of cases with and without central increased diffusivity using the Mann-Whitney U test.

Main Results:

  • 16% of eligible cases (4/25) exhibited centrally increased diffusivity.
  • These cases had significantly larger infarct volumes (117,182 mm³ vs. 36,995 mm³).
  • Higher apparent diffusion coefficient (ADC) values and ADC ratios were observed in the infarct core, with 75% experiencing seizures compared to 0% in the other group.

Conclusions:

  • Centrally increased diffusivity in PAIS is linked to larger stroke volumes and confirmed infarcted tissue.
  • This unusual MRI finding requires awareness among radiologists to prevent underestimation of infarct size and misdiagnosis.