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[Recommendations for imaging neonatal ischemic stroke].

B Husson1, C Durand2, L Hertz-Pannier3

  • 1AP-HP, centre national de référence de l'AVC de l'enfant et service de radiologie pédiatrique, Hôpital Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, Le Kremlin-Bicêtre, 94270 France.

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|September 5, 2017
PubMed
Summary
This summary is machine-generated.

Neuroimaging, particularly MRI with diffusion-weighted imaging (DWI), is crucial for diagnosing neonatal arterial ischemic stroke (NAIS). Optimal timing for lesion assessment is days 2-4 post-injury, correlating with motor and visual outcomes.

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Area of Science:

  • Pediatric Radiology
  • Neonatal Neurology
  • Neuroimaging

Background:

  • Neonatal arterial ischemic stroke (NAIS) diagnosis and prognosis rely heavily on neuroimaging.
  • Establishing clear clinical neuroimaging guidelines is essential for accurate diagnosis, optimal timing, and prognostic assessment.

Purpose of the Study:

  • To define clinical neuroimaging guidelines for NAIS diagnosis.
  • To optimize the timing of imaging for NAIS assessment.
  • To evaluate the prognostic value of different imaging techniques in NAIS.

Main Methods:

  • Systematic literature search of Medline (PubMed) for NAIS studies.
  • Analysis of 110 selected articles by pediatric radiology experts.
  • Application of common methodology for guideline elaboration.

Main Results:

  • MRI with diffusion-weighted imaging (DWI) and T1, T2, T2*-weighted sequences is recommended for suspected NAIS.
  • Acute lesions show hypersignal on DWI with decreased ADC in the initial hours.
  • Optimal evaluation of lesion extent is between days 2-4, correlating with motor and visual outcomes.
  • Ultrasound (US) has limited value for NAIS diagnosis; CT has no added value compared to MRI.
  • Motor outcome correlates with lesion extent and corticospinal tract injury; secondary atrophy predicts hemiplegia.
  • Visual outcome is compromised in posterior cerebral artery territory lesions.

Conclusions:

  • MRI, especially DWI, is the primary neuroimaging modality for NAIS diagnosis and prognosis.
  • Specific imaging findings on MRI correlate with neurological outcomes.
  • Guidelines are established for optimal imaging protocols and timing in NAIS.