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Predicting Progression of Intracranial Arteriopathies in Childhood Stroke With Vessel Wall Imaging
Nicholas V Stence1, Lisa L Pabst2, Amanda L Hollatz2
1From the Department of Radiology (N.V.S., D.M.M.) and Departments of Pediatrics and Pediatric Neurology (T.J.B.), Children's Hospital Colorado, Aurora; and Hemophilia and Thrombosis Center (L.L.P., A.L.H., T.J.B.), Department of Anesthesiology (P.S.H., R.J.T.), and Department Neurology (S.P.), University of Colorado Denver, Aurora. nicholas.stence@ucdenver.edu.
Insights
Children with stroke and enhancing arteriopathies on vessel wall imaging (VWI) show a higher risk of disease progression. VWI may help identify pediatric stroke patients needing closer monitoring for progressive arterial disease.
Area of Science:
- Pediatric neurology
- Neuroradiology
- Vascular imaging
Background:
- Childhood arterial ischemic stroke is often linked to intracranial arteriopathy.
- This arteriopathy can progress within the first 3 to 6 months post-stroke.
Purpose of the Study:
- To investigate if enhancing arteriopathies on vessel wall imaging (VWI) predict progression in pediatric stroke.
- To assess the utility of VWI in identifying children at risk for arteriopathy progression.
Main Methods:
- Retrospective review of pediatric stroke cases with VWI and follow-up MRI.
- Systematic analysis of VWI findings, arteriopathy categorization, and progression using CACADE definitions.
- Inclusion criteria: 1 month to 20 years, arterial ischemic stroke, VWI, and follow-up MRA.
Main Results:
- Strong vessel wall enhancement was observed in 12 of 16 pediatric stroke cases.
- 83% of cases with strong enhancement showed arteriopathy progression (10/12).
- No progression was observed in cases without strong enhancement (0/4), P=0.008.
Conclusions:
- Vessel wall imaging (VWI) shows potential in identifying children with stroke at higher risk for progressive arterial disease.
- VWI may aid in selecting pediatric stroke patients for closer monitoring and management.
Background And Purpose:
Childhood arterial ischemic stroke is frequently associated with an intracranial arteriopathy that often progresses in the first 3 to 6 months post stroke. We hypothesized that children with enhancing arteriopathies on vessel wall imaging (VWI) would have a higher risk of arteriopathy progression than those without enhancement.
Methods:
Our institutional radiographic database was searched for cases of childhood stroke with VWI. Inclusion criteria consisted of age ranging from 1 month through 20 years, diagnosis of arterial ischemic stroke, available VWI, and follow-up magnetic resonance angiogram. Imaging was reviewed to systematically describe VWI findings, categorize arteriopathies, steroid therapy, and identify progressive arteriopathies using CACADE definitions.
Results:
Sixteen cases of childhood stroke at Children's Hospital Colorado between January 1, 2010 and July 1, 2016 were reviewed. Strong vessel wall enhancement at presentation was associated with progressive arteriopathy in 83% of cases (10/12), when compared with 0% (0/4) without strong enhancement (P=0.008).
Conclusions:
Our case series demonstrates the potential benefit of VWI in children with stroke because it may identify patients who will have progressive arterial disease.
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