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Imaging Predictors of Neurologic Outcome After Pediatric Arterial Ischemic Stroke
Bin Jiang1, Nancy K Hills2, Rob Forsyth3
1Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA (B.J., Y.L., G.Z., M.W.).
Insights
In childhood arterial ischemic stroke, larger infarcts and younger age predict worse outcomes, but weakly. Specific lesion locations are less predictive when infarct size is considered.
Area of Science:
- Neurology
- Pediatric Stroke
- Neuroimaging
Background:
- Childhood arterial ischemic stroke (AIS) is a significant cause of long-term disability.
- Predicting neurological outcomes in pediatric AIS is crucial for management and prognosis.
- Initial imaging characteristics may offer predictive value for long-term outcomes.
Purpose of the Study:
- To determine if initial neuroimaging features independently predict 1-year neurological outcomes in pediatric AIS patients.
- To investigate the association between infarct volume, location, hemorrhagic transformation, and neurological outcomes.
Main Methods:
- Analysis of prospectively collected data from 288 pediatric AIS patients (VIPS study).
- Measurement of infarct volume and location on acute MRI; assessment of hemorrhagic transformation.
- Neurological outcome assessed using the Pediatric Stroke Outcome Measure at 1 year.
- Univariate and multivariable logistic regression models used to analyze associations.
Main Results:
- Larger infarct volumes and younger age at stroke onset were associated with poorer outcomes, though the association was weak.
- Infarcts in specific locations (uncinate fasciculus, angular gyrus, insular cortex) were initially linked to poorer outcomes.
- Location-based predictions lost significance when infarct volume was included in multivariable models.
- Hemorrhagic transformation did not predict neurological outcomes.
Conclusions:
- In pediatric AIS, larger infarct volume and younger age are associated with poorer outcomes, but with modest predictive strength.
- Specific infarct locations are less predictive than infarct volume when assessing 1-year neurological outcomes.
- Disruption of critical neural networks by infarcts may disproportionately impact outcomes in childhood AIS.
Background And Purpose:
To assess whether initial imaging characteristics independently predict 1-year neurological outcomes in childhood arterial ischemic stroke patients.
Methods:
We used prospectively collected demographic and clinical data, imaging data, and 1-year outcomes from the VIPS study (Vascular Effects of Infection in Pediatric Stroke). In 288 patients with first-time stroke, we measured infarct volume and location on the acute magnetic resonance imaging studies and hemorrhagic transformation on brain imaging studies during the acute presentation. Neurological outcome was assessed with the Pediatric Stroke Outcome Measure. We used univariate and multivariable ordinal logistic regression models to test the association between imaging characteristics and outcome.
Results:
Univariate analysis demonstrated that infarcts involving uncinate fasciculus, angular gyrus, insular cortex, or that extended from cortex to the subcortical nuclei were significantly associated with poorer outcomes with odds ratios ranging from 1.95 to 3.95. All locations except the insular cortex remained significant predictors of poor outcome on multivariable analysis. When infarct volume was added to the model, the locations did not remain significant. Larger infarct volumes and younger age at stroke onset were significantly associated with poorer outcome, but the strength of the relationships was weak. Hemorrhagic transformation did not predict outcome.
Conclusions:
In the largest pediatric arterial ischemic stroke cohort collected to date, we showed that larger infarct volume and younger age at stroke were associated with poorer outcomes. We made the novel observation that the strength of these associations was modest and limits the ability to use these characteristics to predict outcome in children. Infarcts affecting specific locations were significantly associated with poorer outcomes in univariate and multivariable analyses but lost significance when adjusted for infarct volume. Our findings suggest that infarcts that disrupt critical networks have a disproportionate impact upon outcome after childhood arterial ischemic stroke.
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