Computed Tomography of Pediatric Stroke
Section snippets
Radiation Exposure
There are a number of challenges in the routine clinical use of CTA, and CT scanning in general, for the diagnosis of neurological disease in the pediatric population. The effects of ionizing radiation exposure for patients requiring CT scans have become a topic of increased public health concern in recent years. This issue is particularly important for the pediatric population given increased ionizing radiation sensitivity and longer life expectancy, thus yielding greater estimated opportunity
Ischemic Stroke
Pediatric stroke is relatively uncommon, with an estimated incidence of 2 to 3 per 100,000 per year.12 The etiologies of stroke in the pediatric population are typically different and slightly more varied than in adults. In adults ischemic infarction is more common, often the result of atherosclerotic disease, and is much more common than hemorrhage as a cause of clinical stroke. Complete vascular assessment including both intracranial and extracranial vessels is essential for adult cases as
Cases
The following cases illustrate many of the issues discussed above.
Summary
In conclusion, CT angiography is an effective noninvasive method for evaluation of the intracranial and extracranial circulation. There are some technical considerations that must be addressed in the performance of CT scanning and CTA, but these challenges are not insurmountable. In children, CT scanning and CTA can be used effectively in the diagnosis of brain ischemia, intracranial hemorrhage, in the setting of blunt and penetrating cervical trauma, and in the diagnosis of select vascular
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Cited by (14)
Special considerations in infants and children
2015, Handbook of Clinical NeurologyCitation Excerpt :Finally, CT angiography may be utilized to assess vascular injuries, most often screening for arterial dissection (discussed in more detail below). However, this involves a significant volume of contrast that must be instilled rapidly, creating limitations in younger children with smaller caliber intravenous lines (Atkinson, 2006). The development of MRI techniques using short acquisition times as well as “moving target” software to correct for patient motion now make MRI a feasible alternative for trauma screening for brain as well as spine imaging (Forbes et al., 2001; Missios et al., 2008).
Arterial ischemic stroke in children
2013, Neuroimaging Clinics of North AmericaCitation Excerpt :In the early stage of ischemia, CT findings can be subtle and a small lesion within the posterior fossa can be missed. Computed tomographic angiography (CTA) can provide further valuable information about the intracranial and extracranial circulation.77 Arterial dissection, large-vessel occlusion, and stenosis of the circle of Willis can be readily identified on CTA.
Diagnosis and Management of Pediatric Arterial Ischemic Stroke
2010, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :CT angiography (CTA) is a non-invasive method for evaluation intracranial and extracranial circulation. CTA performed in early stages of cerebral ischemia may provide crucial information regarding cerebral circulation.68 Disadvantages of CTA include radiation exposure, use of intravenous contrast, and the difficulty in timing the contrast bolus in small children.
Radiological strategy in acute stroke in children
2010, European Journal of RadiologyCitation Excerpt :However, most previous studies do not focus on neuroradiological features during emergency [12,16–18], and there is scant information about the role of neuroradiology in the assessment of pediatric stroke etiology in the acute phase. Emergency pediatric patients with cerebrovascular disorders generally require intensive investigation with computed tomography (CT) and magnetic resonance (MR) imaging (including angiographic and diffusion-weighted studies) [19–22]. Intra-arterial digital subtraction angiography (IADSA) is sometimes helpful for diagnosis of etiology, and a combination of imaging modalities is often required.
Joint Quality Improvement Guidelines for Pediatric Arterial Access and Arteriography: From the Societies of Interventional Radiology and Pediatric Radiology
2010, Journal of Vascular and Interventional RadiologyCitation Excerpt :Improvements in coil design and higher-field MR units (ie, ≥3.0 T) also have significantly improved spatial resolution of vascular imaging (127). The role of CT angiography is also increasing in importance (128,129). Unique technical issues such as contrast agent volume, injection rates, sedation, radiation dose, breath-holding factors, and timing of scan initiation must be addressed to successfully perform pediatric CT angiography (130,131).
MRI in paediatric hypoxic-ischemic disease, metabolic disorders and malformations-A review
2008, European Journal of RadiologyCitation Excerpt :If dissection is assumed, T1-w images of the neck with fat saturation may be useful to look for intramural haematoma of the large extra-cranial vessels, as well as contrast-enhanced extra-cranial MRA. Though computed tomography angiography (CTA) provides better spatial and temporal resolution than MRA, its high radiation burden restricts its liberal use especially in paediatrics [17]. Perfusion-weighted imaging in childhood stroke may give additional valuable information about lack of cerebral blood flow in certain regions particularly in early stroke stages, and delivers information about the severity of a stenosis and the efficacy of collateral circulation [1,18].