Background and Aim Studies performed in infants with perinatal arterial ischemic stroke (PAIS) have shown relations between initial neuro-imaging and neurodevelopmental outcome. However, not all variation in outcome can be explained. It is known from adult stroke studies that (luxury) perfusion of the stroke area is related to outcome. In this study, Arterial Spin Labeling (ASL) MR imaging was used to evaluate (luxury) perfusion in infants with PAIS.
Methods Conventional and ASL MR images (3T) were acquired of three PAIS patients 3–5 days after the ischemic event. Near Infrared Spectroscopy was used to monitor cerebral oxygenation. Follow-up MR imaging was conducted 2–16 weeks after the event.
Results A lower perfusion signal was measured in all infants in the area corresponding with the diffusion-restricted area on the diffusion-weighted images. Furthermore, in one infant, luxury perfusion was visualised in the cortex of the affected area. Measurements of volume flow (Phase-Contrast MR Angiography) and cerebral oxygenation were in agreement with this, suggesting an ischemia-induced vasodilatation. Follow-up ASL MR images in this infant showed a partly recovered perfusion. Initial [fig. 1A] and follow-up ASL images [Fig. 1B] of this infant are shown.
Conclusion Arterial Spin Labeling MR imaging can be used to evaluate (luxury) perfusion in the stroke area after PAIS. In the future, relations between ASL imaging findings and outcome should be drawn.