Fluid-Attenuated Inversion Recovery Correlates with Stroke Onset in Childhood Arterial Ischemic Stroke

Area of Science:

• Pediatric Neurology
• Neuroradiology
• Stroke Imaging

Background:

• Time since stroke onset is crucial for recanalization therapy safety and efficacy in adults.
• FLAIR hyperintense signal on MRI is a common proxy for time since stroke in adults.
• The timing of FLAIR hyperintensity in childhood stroke is not well-established, posing a challenge given that stroke onset time is often unknown in pediatric cases.

Purpose of the Study:

• To investigate the time to FLAIR hyperintensity in children following stroke onset.
• To determine if FLAIR signal changes in pediatric stroke are comparable to those observed in adults.
• To assess the potential utility of FLAIR imaging for estimating time since stroke in children.

Main Methods:

• Bayesian accelerated failure time models were employed to analyze brain MRI data.
• The study included 72 children (37 girls) with stroke, with MRIs performed within 24 hours of stroke onset.
• FLAIR imaging was analyzed to determine the presence and timing of hyperintense signals.

Main Results:

• The median estimated time to FLAIR presence was 5.4 hours for all patients and 6.0 hours for anterior circulation strokes.
• For all patients, a 50% chance of stroke occurring more than 5.4 hours ago was observed when no FLAIR hyperintensity was present.
• For anterior circulation strokes without FLAIR hyperintensity, there was a 50% chance the stroke occurred more than 6.0 hours ago.

Conclusions:

• FLAIR signal hyperintensity is a viable method for estimating time since stroke ictus in childhood stroke.
• The timing of FLAIR signal changes in children appears similar to that in adults.
• This suggests that children may benefit from similar time windows for effective recanalization therapies as adults.