Quick Brain MRI with Diffusion-Weighted Imaging as a First Imaging Modality in Pediatric Stroke

Publication date: Available online 9 October 2017
Source:Pediatric Neurology
Author(s): Alison Christy, Charles Murchison, Jenny L. Wilson
BackgroundDiagnostic delay hinders management of pediatric arterial ischemic stroke. Quick-brain MRI with diffusion-weighted imaging sequences (QB+DWI) may provide a rapid diagnosis without the ionizing radiation of a computed tomography (CT) scan.MethodsThis was a retrospective chart review of children 1 month to 18 years old with acute arterial ischemic stroke hospitalized at our institution between January 2010 and January 2017. We evaluated sensitivity and time to diagnostic study based on first imaging study (CT or QB+DWI).ResultsTwenty-five patients met inclusion criteria. Children most often presented to the emergency room (60%) while 40% presented while already hospitalized. Eleven patients (44%) were initially assessed with CT, 10 (40%) with QB+DWI, and 4 (16%) with a full MRI. Compared with children receiving CT, children with QB+DWI as first study were younger (5.8 vs. 14.1 years, t=4.19, P<0.001) and more likely to be hospitalized at the time of arterial ischemic stroke (70% vs. 18.2%, RR 3.11, P=0.03). CT was 27.3% sensitive for ischemia, compared with 100% sensitivity of QB+DWI. The overall median time from presentation to diagnostic imaging was 4.3 hours, with no differences between CT and QB+DWI groups, though QB+DWI group had shorter median time from first imaging to diagnostic imaging (W=95, P=0.002). There were no clinically significant missed findings on QB+DWI.ConclusionsIn a small study of children with arterial ischemic stroke, QB+DWI was more sensitive than CT for ischemia without missing clinically significant findings. QB+DWI may be considered as first study for some children presenting with symptoms of arterial ischemic stroke.



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