Abstract
Background and Purpose: Larger infarct volume as a percent of supratentorial brain volume (SBV) predicts poor outcome and hemorrhagic transformation in childhood arterial ischemic stroke (AIS). In perinatal AIS, higher scores on a modified pediatric version of the Alberta Stroke Program Early CT Score using acute MRI (modASPECTS) predict later seizure occurrence. The objectives were to establish the relationship of modASPECTS to infarct volume in perinatal and childhood AIS and to establish the interrater reliability of the score. Methods: We performed a cross sectional study of 31 neonates and 40 children identified from a tertiary care center stroke registry with supratentorial AIS and acute MRI with diffusion weighted imaging (DWI) and T2 axial sequences. Infarct volume was expressed as a percent of SBV using computer-assisted manual segmentation tracings. ModASPECTS was performed on DWI by three independent raters. The modASPECTS were compared among raters and to infarct volume as a percent of SBV. Results: ModASPECTS correlated well with infarct volume. Spearman rank correlation coefficients (ρ) for the perinatal and childhood groups were 0.76, p < 0.001 and 0.69, p < 0.001, respectively. Excluding one perinatal and two childhood subjects with multifocal punctate ischemia without large or medium sized vessel stroke, ρ for the perinatal and childhood groups were 0.87, p < 0.001 and 0.80, p < 0.001, respectively. The intraclass correlation coefficients for the three raters for the neonates and children were 0.93 [95% confidence interval (CI) 0.89–0.97, p < 0.001] and 0.94 (95% CI 0.91–0.97, p < 0.001), respectively. Conclusion: The modified pediatric ASPECTS on acute MRI can be used to estimate infarct volume as a percent of SBV with a high degree of validity and interrater reliability.
Highlights
Arterial ischemic stroke (AIS) affects between 1.2 and 13 pediatric patients per 100,000 person-years in developed countries (Giroud et al, 1995; Fullerton et al, 2003, 2007), and up to 85% have residual neurological deficits (Ganesan et al, 2000)
We further evaluated whether modASPECTS can reliably classify subjects as high-risk for poor outcome due to large infarct volume as, previously described, in which infarct volume ≥5% of supratentorial brain volume (SBV) was predictive of hemorrhagic transformation (HT) and poor outcome (Beslow et al, 2011)
Of these 46 subjects, 10 had MRIs performed at other institutions that were non-DICOM format compliant and could not be measured in ITK-SNAP; 2 did not have axial T2 for total SBV measurement; and 3 had diffusion weighted imaging (DWI) that was too degraded for measurement
Summary
Arterial ischemic stroke (AIS) affects between 1.2 and 13 pediatric patients per 100,000 person-years in developed countries (Giroud et al, 1995; Fullerton et al, 2003, 2007), and up to 85% have residual neurological deficits (Ganesan et al, 2000). Automatic segmentation methods are unreliable in children, in neonates and younger children, due to incomplete myelination These measurements are often performed by manual segmentation techniques that are time consuming and require post-image processing that cannot be performed or quickly in real time. Larger infarct volume as a percent of supratentorial brain volume (SBV) predicts poor outcome and hemorrhagic transformation in childhood arterial ischemic stroke (AIS). Methods:We performed a cross sectional study of 31 neonates and 40 children identified from a tertiary care center stroke registry with supratentorial AIS and acute MRI with diffusion weighted imaging (DWI) andT2 axial sequences. Conclusion: The modified pediatric ASPECTS on acute MRI can be used to estimate infarct volume as a percent of SBV with a high degree of validity and interrater reliability
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