Prediction of Outcome in New-Born Infants with Arterial Ischaemic Stroke Using Diffusion-Weighted Magnetic Resonance Imaging
Abstract
OBJECTIVE: The aim of this study was to assess the additional value of diffusion-weighted magnetic resonance imaging (DW-MRI) compared to conventional magnetic resonance imaging (MRI) in new-born infants with arterial ischaemic stroke, with regard to the prediction of neurodevelopmental outcome. METHODS: Neonatal DW-MRI data were available in 15 infants with a gestational age of > or = 35 weeks and repeat MRI data were obtained in 12 of the 14 survivors. T(1)- and T(2)-weighted transverse images were obtained as well as 4-mm DWI slices. ADC maps were calculated in manually selected regions on the basis of the DWI scans. All 14 survivors were seen in the follow-up clinic and 12 were > 18 months when last seen. RESULTS: T (2) hyperintensity was detected in the descending white matter tracts at the level of the internal capsule in 7 infants and in only one of these also at the level of the cerebral peduncles. Increased signal intensity (SI) was seen on DW-MRI in 8 infants in the descending white matter tract ipsilateral to the territorial infarct at the level of the internal capsule and in 5 of these also at the level of the cerebral peduncles. ADC maps were available in 12 infants. ADC values were calculated at the level of the cerebral peduncles, using the contralateral side as a reference value. A significantly reduced value was found in 3 of the 5 infants who showed an increased SI on DW-MRI. ADC maps were not available in the other two. Five of the seven infants with abnormalities on DW-MRI/ADC of the corticospinal tracts developed a mild to moderate hemiplegia, one showed an asymmetry of tone and one with only involvement of the anterior part of the internal capsule was normal at follow-up. Wallerian degeneration, seen at the level of the cerebral peduncles and/or the PLIC on the repeat MRI, was seen in the 5 infants who had shown acute changes of the corticospinal tracts in the neonatal period and who went on to develop motor sequelae. CONCLUSIONS: Compared to MRI, DW-MRI and ADC maps provided additional, quantitative data of acute corticospinal tract injury at an early time point after the insult, especially at the level of the cerebral peduncles. The presence of increased SI on DW-MRI at the level of the PLIC and the cerebral peduncles in new-born infants with arterial ischaemic stroke is followed by Wallerian degeneration and subsequent development of hemiplegia.
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Involvement of the corticospinal tracts (at the level of the internal capsule and/or cerebral peduncles) in acute ischaemic brain injury predicts motor impairment in other neonatal populations.
“Involvement of the corticospinal tracts (at the level of the internal capsule and/or cerebral peduncles) in acute ischaemic brain injury predicts motor impairment in other neonatal populations.20”
From Perioperative neonatal brain injury is associated with worse school-age neurodevelopment in children with critical congenital heart disease (2018) · cites this paper as [20]
Involvement of the posterior limb of the internal capsule and cerebral peduncles on diffusion MRI is predictive of unilateral spastic cerebral palsy, which can already be present from 3 months of age.
“Involvement of the posterior limb of the internal capsule and cerebral peduncles on dMRI is predictive of unilateral spastic cerebral palsy, which can already be present from 3 months of age onwards.87”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [87]
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Self-citationPediatric Stroke: Past, Present and Future
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“More recently, diffusion-weighted (DWI) MRI signal abnormalities of the ipsilateral cerebral peduncle and posterior limb of the internal capsule were strongly correlated with subsequent Wallerian degeneration and resultant hemiplegia [44].”
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Self-citationCerebellar Atrophy in Childhood Arterial Ischemic Stroke
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Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke
Kirton, A., Williams, E. D., Dowling, M. M., et al. (2016) · International Journal of Stroke · doi:10.1177/1747493016666089 · Cited by 29 · see citing works
“Additional specific criteria for this substudy were (1) radiographically confirmed unilateral MCA AIS, (2) availability of high-quality acute (at diagnosis) and follow-up (5–14 days) diffusion-weighed imaging (DWI), and (3) Pediatric Stroke Outcome Measure (PSOM) score at 12 months.”
BackgroundDiffusion Imaging of Cerebral Diaschisis in Neonatal Arterial Ischemic Stroke
Srivastava, R., Rajapakse, T., Carlson, H. L., et al. (2019) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2019.04.012 · Cited by 27 · see citing works
Baak, L. M., van der Aa, N. E., Verhagen, A. A. E., Dudink, J., Groenendaal, F., Nijboer, C. H. A., Benders, M. J. N. L., & Wagenaar, N. (2022) · Pediatric Research · doi:10.1038/s41390-022-02433-w · Cited by 26 · see citing works
Self-citationAmrani, F. A., Kwan, S., Gilbert, G., Saint‐Martin, C., Shevell, M. I., & Wintermark, P. (2017) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2017.04.025 · Cited by 26 · see citing works
“, anterior and posterior white matter) may be indirect by way of the transneuronal degeneration related to associated damage in other interconnected areas of the brain [1,24,42-44].”
BackgroundHypoxic-Ischemic Injury in the Term Infant
Inder, T. E., & Volpe, J. J. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-42876-7.00020-x · Cited by 26 · see citing works
Goldenberg, N. A., Everett, A. D., Graham, D. R. M., Bernard, T. J., & Nowak‐Göttl, U. (2014) · PROTEOMICS - CLINICAL APPLICATIONS · doi:10.1002/prca.201400062 · Cited by 25 · see citing works
“In perinatal/neonatal ischemic stroke, abnormal background on early neonatal encephalography [89], involvement of the basal ganglia and internal capsule [89] (particularly the posterior limb of the internal capsule [90]) on MRI, and degree of descending corticospinal tract involvement [91] are each associated with the…”
BackgroundRyll, U. C., Wagenaar, N., Verhage, C. H., Blennow, M., de Vries, L. S., & Eliasson, A. (2019) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2019.04.004 · Cited by 25 · see citing works
Self-citationSerial magnetic resonance imaging in a rat pup filament stroke model
Ashwal, S., Tone, B., Tian, H., et al. (2006) · Experimental Neurology · doi:10.1016/j.expneurol.2006.06.004 · Cited by 25 · see citing works
MRI for neurodevelopmental prognostication in the high-risk term infant
Massaro, A. N. (2015) · Seminars in Perinatology · doi:10.1053/j.semperi.2015.01.009 · Cited by 24 · see citing works
Liu, X., Tian, W., Li, L., et al. (2011) · European Journal of Radiology · doi:10.1016/j.ejrad.2010.12.053 · Cited by 24 · see citing works
“Although the hyperintensity on DWI along CST, which is remote from the area of ischemic stroke, has been recognized to correlate with motor function outcome [6–8,16], Mazumdar et al.”
Pediatric Arterial Ischemic Stroke
Bernard, T. J., & Goldenberg, N. A. (2010) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2009.11.007 · Cited by 24 · see citing works
“posterior limb of the internal capsule or the cerebral peduncles on magnetic resonance with diffusion-weighted imaging and ADC mapping in neonatal acute AIS is associated with the development of unilateral motor deficit.(69,70) Most recently,”
BackgroundImaging Corticospinal Degeneration in Neonatal Rats with Unilateral Cerebral Infarction
Lama, S., Qiao, M., Kirton, A., et al. (2011) · Experimental Neurology · doi:10.1016/j.expneurol.2011.01.002 · Cited by 23 · see citing works
“…the descending cortico-spinal tract at a range of times following ischemic damage to the cortex and internal capsule (Mazumdar et al. 2003; De Vries et al. 2005; Groenendaal et al. 2006; Kirton et al. 2007; Domi et al. 2009), there is no direct information on the corresponding tissue changes…”
BackgroundInfluentialJones, K., Hawkins, C. E., Armstrong, D. C., et al. (2012) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.12010 · Cited by 22 · see citing works
Evaluation and Acute Management of Ischemic Stroke in Infants and Children
Amlie‐Lefond, C. (2018) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000559 · Cited by 22 · see citing works
Imaging for Diagnosis and Treatment of Cerebral Palsy
Shimony, J. S., Lawrence, R. K., Neil, J. J., et al. (2008) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0b013e3181870b22 · Cited by 21 · see citing works
Anatomic Changes and Imaging in Assessing Brain Injury in the Term Infant
Lawrence, R. K., & Inder, T. E. (2008) · Clinics in Perinatology · doi:10.1016/j.clp.2008.07.013 · Cited by 21 · see citing works
Ilves, N., Ilves, N., Lõo, S., et al. (2022) · BMC Neurology · doi:10.1186/s12883-022-02550-3 · Cited by 21 · see citing works
Diffusion-Weighted MR Imaging: Pediatric Clinical Applications
Sagar, P., & Grant, P. E. (2006) · Neuroimaging Clinics of North America · doi:10.1016/j.nic.2005.11.003 · Cited by 21 · see citing works
Hypoxic-Ischemic Injury in the Term Infant
Kinney, H. C., & Volpe, J. J. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-42876-7.00018-1 · Cited by 19 · see citing works
Arca, G., Arnáez, J., Agut, T., et al. (2019) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2018-316680 · Cited by 20 · see citing works
Imaging Developmental and Interventional Plasticity Following Perinatal Stroke
Craig, B. T., Hilderley, A. J., Kirton, A., & Carlson, H. L. (2020) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/cjn.2020.166 · Cited by 21 · see citing works
Bedside neurophysiological tests can identify neonates with stroke leading to cerebral palsy
Nevalainen, P., Metsäranta, M., Toiviainen‐Salo, S., et al. (2019) · Clinical Neurophysiology · doi:10.1016/j.clinph.2019.02.017 · Cited by 19 · see citing works
- Authors
- De Vries, L. S., Van der Grond, J., Van Haastert, I. C., & Groenendaal, F.
- Affiliations
- University Medical Center Utrecht (NL)
- ORCID
- Groenendaal, F.
- Venue
- Neuropediatrics
- Publisher
- Georg Thieme Verlag KG
- Published
- 2005-02
- Volume
- 36
- Issue
- 1
- Pages
- 12-20
- ISSN
- 0174-304X (ISSN-L)
- 1439-1899
- OpenAlex
- W1992914115
- Cited by
- 193
- References
- 0
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 9 · 2020: 3 · 2019: 15 · 2018: 6 · 2017: 12 · 2016: 10 · 2015: 12 · 2014: 6 · 2013: 13 · 2012: 12
- FWCI
- 11.74
- Type
- journal article
- Language
- de
- Open access
- closed
- Locations
- Neuropediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
- Keywords
- diffusion-weighted imaging, apparent diffusion coefficient, corticospinal tract injury, cerebral peduncle, internal capsule, periventricular leukoencephalopathy, Wallerian degeneration, neurodevelopmental outcomes, hemiplegia, motor sequelae, prognosis, white matter injury, gestational age, T2 hyperintensity
- MeSH terms
- Brain Mapping, Cerebral Infarction, Brain Ischemia, Female, Follow-Up Studies, Humans, Image Processing, Computer-Assisted, Infant, Newborn, Magnetic Resonance Imaging, Male, Neurologic Examination, Predictive Value of Tests, Retrospective Studies, Weights and Measures, Middle Cerebral Artery, Diffusion Magnetic Resonance Imaging
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