Evaluation of perinatal arterial ischemic stroke using noninvasive arterial spin labeling perfusion MRI

Background:Arterial spin labeling (ASL) magnetic resonance imaging (MRI) can evaluate brain perfusion in neonates noninvasively. The aim of this study was to investigate whether ASL MRI can demonstrate perfusion abnormalities in neonates diagnosed with perinatal arterial ischemic stroke (PAIS).Methods:Pulsed ASL perfusion MR images were acquired in the subacute stage (5–6 d after birth) and at follow-up (13 d to 16 wk after birth) in four PAIS patients. Images were visually evaluated for hypo- and hyperperfusion. In addition, cerebral oxygenation was monitored using near infrared spectroscopy (NIRS).Results:In three PAIS patients, ASL images showed hypoperfusion in the stroke area. In one of these, hyperperfusion was visualized in the periphery of the stroke area. In one PAIS patient, hyperperfusion was seen in the stroke area. In all infants, cerebral oxygenation was higher in the infarcted hemisphere as compared with the contralateral hemisphere. Follow-up ASL images showed partial recovery of perfusion in the stroke area.Conclusion:ASL perfusion MRI is able to reliably detect hypo- and hyperperfusion in PAIS patients and can be used to monitor the evolution of perfusion after an ischemic event.

[1]  M. Benders,et al.  Changes in carotid blood flow after unilateral perinatal arterial ischemic stroke , 2012, Pediatric Research.

[2]  Jeroen Hendrikse,et al.  Regional changes in brain perfusion during brain maturation measured non-invasively with Arterial Spin Labeling MRI in neonates. , 2013, European Journal of Radiology.

[3]  L. D. de Vries,et al.  Risk factors for perinatal arterial ischaemic stroke in full-term infants: a case-control study , 2012, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[4]  Xavier Golay,et al.  Pulsed star labeling of arterial regions (PULSAR): A robust regional perfusion technique for high field imaging , 2005, Magnetic resonance in medicine.

[5]  P. Bandettini,et al.  QUIPSS II with thin‐slice TI1 periodic saturation: A method for improving accuracy of quantitative perfusion imaging using pulsed arterial spin labeling , 1999, Magnetic resonance in medicine.

[6]  J. Detre,et al.  Magnetic resonance perfusion imaging in acute ischemic stroke using continuous arterial spin labeling. , 2000, Stroke.

[7]  Gunnar Naulaers,et al.  Monitoring Neonatal Regional Cerebral Oxygen Saturation in Clinical Practice: Value and Pitfalls , 2008, Neonatology.

[8]  Simon K. Warfield,et al.  New Insights in Perinatal Arterial Ischemic Stroke by Assessing Brain Perfusion , 2011, Translational Stroke Research.

[9]  Daniel J. Licht,et al.  Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. , 2004 .

[10]  F. Bel,et al.  Cerebral Oxygenation During the First Days of Life in Preterm and Term Neonates: Differences Between Different Brain Regions , 2011, Pediatric Research.

[11]  Jeroen Hendrikse,et al.  Whole-Brain Arterial Spin Labeling Perfusion MRI in Patients With Acute Stroke , 2012, Stroke.

[12]  Floris Groenendaal,et al.  Pre-wallerian degeneration in the neonatal brain following perinatal cerebral hypoxia-ischemia demonstrated with MRI. , 2006, Seminars in perinatology.

[13]  S K Warfield,et al.  Brain Perfusion in Asphyxiated Newborns Treated with Therapeutic Hypothermia , 2011, American Journal of Neuroradiology.

[14]  A. Kirton,et al.  Advances in perinatal ischemic stroke. , 2009, Pediatric neurology.

[15]  Y. Fujii,et al.  Ictal focal hyperperfusion demonstrated by arterial spin-labeling perfusion MRI in partial epilepsy status , 2012, Neuroradiology.

[16]  U. Ruotsalainen,et al.  Cerebral metabolic rate for glucose during the first six months of life: an FDG positron emission tomography study. , 1996, Archives of disease in childhood. Fetal and neonatal edition.

[17]  Gil Wernovsky,et al.  Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. , 2004, The Journal of thoracic and cardiovascular surgery.

[18]  Karam Sidaros,et al.  Noninvasive Measurements of Regional Cerebral Perfusion in Preterm and Term Neonates by Magnetic Resonance Arterial Spin Labeling , 2006, Pediatric Research.

[19]  Frank van Bel,et al.  Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their Relation to Outcome The authors have indicated they have no financial relationships relevant to this article to disclose. , 2006, Pediatrics.

[20]  M. Zilbovicius,et al.  Changes in regional cerebral blood flow during brain maturation in children and adolescents. , 1992, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[21]  J. Detre,et al.  Why perfusion in neonates with congenital heart defects is negative--technical issues related to pulsed arterial spin labeling. , 2006, Magnetic resonance imaging.

[22]  G. Cioni,et al.  Neonatal cerebral infarction and neuromotor outcome at school age. , 2004, Pediatrics.

[23]  M. Weiss,et al.  Reproducibility of cerebral oxygenation measurement in neonates and infants in the clinical setting using the NIRO 300 oximeter* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[24]  Xavier Golay,et al.  A method for rapid in vivo measurement of blood T1 , 2011, NMR in biomedicine.

[25]  V Beaudouin,et al.  Early spontaneous hyperperfusion after stroke. A marker of favourable tissue outcome? , 1996, Brain : a journal of neurology.

[26]  C. Levi,et al.  Arterial Spin Labeling Identifies Tissue Salvage and Good Clinical Recovery After Acute Ischemic Stroke , 2013, Journal of neuroimaging : official journal of the American Society of Neuroimaging.