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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.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]
In the citing paper
“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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Myth: Cerebral palsy cannot be predicted by neonatal brain imaging
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Self-citationNew insights (and new interrogations) in perinatal arterial ischemic stroke
Chabrier, S., Husson, B., Dinomais, M., et al. (2010) · Thrombosis Research · doi:10.1016/j.thromres.2010.10.003 · Cited by 145
“1E and F) [29–33].”
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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.(20) Involvement of the PLIC should always be specifically reviewed when interpreting neonatal MRI and taken into account in f…”
BackgroundSelf-citationAcute Corticospinal Tract Wallerian Degeneration Is Associated With Stroke Outcome
DeVetten, G., Coutts, S. B., Hill, M. D., Goyal, M., Eesa, M., O'Brien, B., Demchuk, A. M., & Kirton, A. (2010) · Stroke · doi:10.1161/strokeaha.109.573287 · Cited by 122
Advances in Perinatal Ischemic Stroke
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“Diffusion-weighted imaging analysis of early corticospinal tract Wallerian degeneration is predictive of neonatal arterial ischemic stroke outcome [38,39].”
BackgroundNeurodevelopment After Perinatal Arterial Ischemic Stroke
Wagenaar, N., Martínez-Biarge, M., van der Aa, N. E., van Haastert, I. C., Groenendaal, F., Benders, M. J. N. L., Cowan, F. M., & de Vries, L. S. (2018) · PEDIATRICS · doi:10.1542/peds.2017-4164 · Cited by 110
Self-citationHusson, B., Hertz‐Pannier, L., Renaud, C., Allard, D., Presles, É., Landrieu, P., Chabrier, S., & for the AVCnn Group (2010) · PEDIATRICS · doi:10.1542/peds.2009-3611 · Cited by 107
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Using cerebral ultrasound effectively in the newborn infant
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“In a study comparing cUS and MRI (4), no major lesions were missed on cUS (1-3) though subtle WM change on cUS and MRI were not consistent; the clinical significance of both observations is still not fully understood.”
BackgroundInfluentialSelf-citationCorticospinal Tract Pre-Wallerian Degeneration
Domi, T., deVeber, G., Shroff, M. M., Pulcine, E., MacGregor, D., & Kirton, A. (2009) · Stroke · doi:10.1161/strokeaha.108.529958 · Cited by 98
“Measures of abnormal DCST-DWI signal were defined as: (1) any positive slice within the DCST at the posterior limb of the internal capsule, midbrain, pons, or medulla; (2) percentage peduncle (%): number of abnormal DCST pixels divided into total peduncle area as measured by freehand and area calculator tools; (3) ped…”
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The internal capsule in neonatal imaging
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Self-citationPatterns of damage in the mature neonatal brain
Triulzi, F. M., Parazzini, C., & Righini, A. (2006) · Pediatric Radiology · doi:10.1007/s00247-006-0203-5 · Cited by 82
“The presence of diffusion restriction at the level of the PLIC or cerebral peduncles in newborns with arterial infarction is regularly followed by subsequent hemiplegia [24].”
BackgroundDelayed neural network degeneration after neonatal hypoxia‐ischemia
Stone, B. S., Zhang, J., Mack, D. W., Mori, S., Martin, L. J., & Northington, F. J. (2008) · Annals of Neurology · doi:10.1002/ana.21517 · Cited by 81
Early intervention after perinatal stroke: opportunities and challenges
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“This is exciting because previous studies that correlate imaging findings with clinical hemiparesis are primarily limited to children with arterial infarcts as the cause of their hemiparesis, many of whom were diagnosed during the perinatal period.(14-17) Our study, however, provides an MR imaging marker that correlat…”
ResultPerinatal stroke: mapping and modulating developmental plasticity
Kirton, A., Metzler, M. J., Craig, B. T., Hilderley, A. J., Dunbar, M., Giuffre, A., Wrightson, J. G., Zewdie, E., & Carlson, H. L. (2021) · Nature Reviews Neurology · doi:10.1038/s41582-021-00503-x · Cited by 77
Holmefur, M., Kits, A., Bergström, J., et al. (2012) · Neurorehabilitation and neural repair · doi:10.1177/1545968312446950 · Cited by 75
Pathways for Neuroimaging of Neonatal Stroke
Lee, S., Mirsky, D. M., Beslow, L. A., Amlie‐Lefond, C., Danehy, A. R., Lehman, L. L., Stence, N. V., Vossough, A., Wintermark, M., & Rivkin, M. J. (2017) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2016.12.008 · Cited by 78
Magnetic resonance imaging in neonatal stroke
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“Restricted diffusion on DWI at the level of the cerebral peduncle has been interpreted as ‘pre-Wallerian’ degeneration of the descending corticospinal tracts and is a predictor of poor motor outcome (22,23).”
BackgroundSelf-citationVermeulen, R. J., van Schie, P. E. M., Hendrikx, L. H., et al. (2008) · Radiology · doi:10.1148/radiol.2492071581 · Cited by 71
Weeke, L. C., Groenendaal, F., Toet, M. C., Benders, M. J. N. L., Nievelstein, R. A. J., van Rooij, L. G. M., & de Vries, L. S. (2014) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.12629 · Cited by 68
Self-citationCerebral Palsy Secondary to Perinatal Ischemic Stroke
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“Recent evidence suggests that restricted diffusion signal within the cerebral peduncle may represent pre–Wallerian degeneration and correlate with poor motor outcome [107].”
BackgroundLong term motor function after neonatal stroke: Lesion localization above all
Dinomais, M., Hertz‐Pannier, L., Groeschel, S., Chabrier, S., Delion, M., Husson, B., Kossorotoff, M., Renaud, C., Tich, S. N. T., & for the AVCnn Study Group (2015) · Human Brain Mapping · doi:10.1002/hbm.22950 · Cited by 64
“Acute diffusion-weighted MRI changes in the cortico-spinal tract (CST) correlate with poor motor outcome [De Vries et al., 2005; Domi et al., 2009; Kirton et al., 2007].”
Backgroundvan der Aa, N. E., Leemans, A., Northington, F. J., Straaten, H. L. M. V., van Haastert, I. C., Groenendaal, F., Benders, M. J. N. L., & de Vries, L. S. (2011) · Stroke · doi:10.1161/strokeaha.111.624858 · Cited by 65
Self-citationSalas, J., Tekes, A., Hwang, M., et al. (2018) · Neonatology · doi:10.1159/000487913 · Cited by 65
Groenendaal, F., Benders, M. J. N. L., & de Vries, L. S. (2006) · Seminars in Perinatology · doi:10.1053/j.semperi.2006.04.005 · Cited by 64
Self-citationClaessens, N. H. P., Kelly, C. J., Counsell, S. J., & Benders, M. J. N. L. (2017) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.13461 · Cited by 59
“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) Acquired stroke and WMI show a trend towards lower psychomotor outcome at the age of 2 years.”
BackgroundNeonatal posterior cerebral artery stroke: clinical presentation, MRI findings, and outcome
van der Aa, N. E., Dudink, J., Benders, M. J. N. L., et al. (2013) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.12055 · Cited by 59
Self-citationTuor, U. I., Morgunov, M. A., Sule, M., Qiao, M., Clark, D., Rushforth, D. A., Foniok, T., & Kirton, A. (2014) · NeuroImage Clinical · doi:10.1016/j.nicl.2014.08.003 · Cited by 57
“Detection of such changes on early subacute diffusion MRI have been described as “ early ” or “ pre ” Wallerian degeneration following perinatal stroke in neonates (De Vries et al., 2005; Kirton et al., 2007).”
BackgroundInfluentialPreterm arterial ischemic stroke
Benders, M. J. N. L., Groenendaal, F., & de Vries, L. S. (2009) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2009.07.002 · Cited by 57
Self-citationDiffusion tensor imaging of the pyramidal tracts in infants with motor dysfunction
Ludeman, N., Berman, J., Wu, Y. J., et al. (2008) · Neurology · doi:10.1212/01.wnl.0000304084.59964.e2 · Cited by 56
Motor and cognitive outcome after specific early lesions of the brain – a systematic review
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“Another limitation of our study is a possible overlap between study populations, for example, this may be the case for the studies from the Hammersmith Hospital(8,32,60,62,64) and those of de Vries et al.(9,16,19,24,26,29,34,35,47,63,68) If overlap was clear, we excluded one of the overlapping studies, that is, the on…”
ResultInfluentialAdvancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke
Kirton, A. (2016) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2016.07.002 · Cited by 60
Neonatal arterial ischaemic stroke: obstetric issues
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“Diffusion-weighted abnormalities of descending corticospinal tracts on initial neonatal MRI of unilateral stroke appear to predict later hemiparesis.(25,26) In children with neonatal SVT, progression to infarction was associated with poor outcome, including motor outcome.”
BackgroundVenkatasubramanian, C., Kleinman, J. T., Fischbein, N. J., et al. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.113.000090 · Cited by 52
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“In this population, MRI is indispensable for early diagnosis of brain injury and helps in identifying infants who are at risk of developing motor sequelae; it is therefore routinely used in many centres.(12,13,18,19) By relating neonatal neuroimaging findings with TMS determined patterns of corticospinal organization…”
BackgroundMethodInfluentialSelf-citationRoze, E., Harris, P. A., Ball, G., Zubiaurre‐Elorza, L., Braga, R. M., Allsop, J. M., Merchant, N. M., Porter, E., Arichi, T., Edwards, A. D., et al. (2011) · Neuroradiology · doi:10.1007/s00234-011-0969-5 · Cited by 48
“Studies have shown that an increased SI at the level of the PLIC and the CP on diffusion weighted images (DWIs), indicating areas of restricted diffusion, is followed by the development of a hemiplegia in infants with AIS [15].”
BackgroundBabsky, A. M., Topper, S. M., Zhang, H., et al. (2008) · Magnetic Resonance in Medicine · doi:10.1002/mrm.21568 · Cited by 45
“A(Nai ) A(Nae ) [Na ]e in mmole/kg wet wt , [2]”
Magnetic Resonance Imaging of Brain Injury in the High-Risk Term Infant
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“During the neonatal period, conventional MRI and diffusion-weighted imaging remain essential for the diagnosis of PAIS and have also shown their value in predicting the development of motor disabilities (3,4,6,9).”
Self-citationThe Vulnerable Newborn Brain: Imaging Patterns of Acquired Perinatal Injury
Ferriero, D. M. (2016) · Neonatology · doi:10.1159/000444896 · Cited by 37
Pediatric ASPECTS predicts outcomes following acute symptomatic neonatal arterial stroke
Mackay, M. T., Slavova, N., Pastore‐Wapp, M., Grunt, S., Stojanovski, B., Donath, S. M., & Steinlin, M. I. (2020) · Neurology · doi:10.1212/wnl.0000000000009136 · Cited by 37
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“…peduncles in some of the above mentioned primary disease entities, mainly focal infarction (Zarifi et al., 2002; McKinstry et al., 2002; Mazumdar et al., 2003; Uchino et al., 2004; Hunt et al., 2004; De Vries et al., 2005; Cowan and de Vries, 2005; Boichot et al., 2006; Groenendaal et al., 2006).”
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Pediatric Arterial Ischemic Stroke
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Perinatal arterial ischemic stroke
Martínez-Biarge, M., Ferriero, D. M., & Cowan, F. M. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64029-1.00011-4 · Cited by 36
Fetal and neonatal neuroimaging
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Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke
Wiedemann, A., Pastore‐Wapp, M., Slavova, N., Steiner, L., Weisstanner, C., Regényi, M., Steinlin, M. I., Grunt, S., Mori, A. C., Bigi, S., et al. (2019) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2019.10.006 · Cited by 33
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Injury to the Cerebellum in Term Asphyxiated Newborns Treated with Hypothermia
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The Course of Apparent Diffusion Coefficient Values following Perinatal Arterial Ischemic Stroke
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Self-citationPediatric Stroke: Past, Present and Future
Friedman, N. (2009) · Advances in Pediatrics · doi:10.1016/j.yapd.2009.08.003 · Cited by 31
“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].”
BackgroundMeta-Analysis of Apparent Diffusion Coefficients in the Newborn Brain
Coats, J. S., Freeberg, A., Pajela, E. G., et al. (2009) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2009.04.013 · Cited by 30
Liauw, L., van der Grond, J., van den Berg‐Huysmans, A. A., et al. (2008) · American Journal of Neuroradiology · doi:10.3174/ajnr.a1188 · Cited by 30
Self-citationCerebellar Atrophy in Childhood Arterial Ischemic Stroke
Mah, S. M., deVeber, G., Wei, X., et al. (2013) · Stroke · doi:10.1161/strokeaha.111.000744 · Cited by 29
Lavery, S., Shah, D. K., Hunt, R. W., et al. (2008) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2007.01270.x · Cited by 29
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
“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
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
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“, 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
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“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
Self-citationSerial magnetic resonance imaging in a rat pup filament stroke model
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“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,”
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Metadata
- 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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