Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI

Intraobserver and interobserver variability for measuring the wall area of the basilar artery at the level of the trigeminal ganglion on high-resolution MR images

We evaluated the intraobserver and interobserver variability for WA measurement of an atherosclerotic BA by using HRMRI. Ten consecutive patients underwent HRMRI, and the WA of the BA at the level of the trigeminal ganglion was measured by 2 independent readers and repeated by 1 reader 1 month later. There was strong agreement for intraobserver and interobserver measurements in the ICC and by the Bland-Altman method. Measurement of the WA in an atherosclerotic BA by HRMRI was reproducible.

Stroke and cerebrovascular disorders

PURPOSE OF REVIEW

Stroke and cerebrovascular disorders in childhood are a cause for significant morbidity in childhood. There is growing emphasis on understanding the mechanisms of stroke so as to inform developments in investigation and management.

RECENT FINDINGS

Advances have been made in the classification of pediatric stroke, aided by clinical and radiological recognition of patterns of injury and differential outcomes dependent on timing of stroke occurrence. Risk factors are multifactorial, with evidence of geographical and national variation. Causality, however, remains difficult to prove. Recent studies highlight a significant association between stroke recurrence and outcome and the presence of steno-occlusive arterial disease, Moyamoya disease and progressive arteriopathy. Focal arteriopathy of childhood is a new term proposed to refine the nomenclature of childhood arteriopathy. The association between infection and childhood stroke is increasingly recognized, with associations with sinovenous thrombosis and childhood arteriopathy. The recommendation to screen for arteriopathy in genetic conditions such as sickle cell disease is now extended to include children with neurofibromatosis type 1. Perfusion and magnetic resonance wall imaging have helped in the determination of the cause of stroke with impact on management in adults. Two new treatment guidelines have been published (American Heart Association and Chest), but barriers remain to the use of thrombolysis in childhood stroke.

SUMMARY

Continued developments in understanding and practice in childhood stroke are encouraging. However, the absence of clinical trials and evidence-based guidelines is limiting. The conduct of such trials is a goal towards which the International Pediatric Stroke Study is moving.