Modified Pediatric ASPECTS Correlates with Infarct Volume in Childhood Arterial Ischemic Stroke

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.

Association of Blood Pressure, Blood Glucose, and Temperature With Neurological Outcome After Childhood Stroke

“…The Brush et al study 4 did not include data on infarct volume or BP at follow-up. Infarct volume was very strongly associated with outcome in our study population, a finding similarly reported by Ganesan et al 19 with pediatric large-vessel strokes and by Beslow et al 28 when using MRI to estimate infarct volume. Our study population included 50 children (51.0%) with cardiac disease, presumably those at high risk for hypertension.…”

“…Finally, a strong association was found between large infarct volume and poor outcome, as expected. 19,28 We believe that future studies should consider infarct volume when assessing predictors associated with outcome.…”

MRI for neurodevelopmental prognostication in the high-risk term infant

“…69,70 Manual and automated quantification of lesion volume have also been demonstrated to be predictive of both motor and cognitive outcomes after IPS. 71,72 Extracorporeal membrane oxygenation Newborns with severe hypoxemic respiratory failure who require life support with ECMO are at high risk for neurodevelopmental compromise, attributable to both pre-ECMO hypoxic-ischemic injuries as well as hemorrhagic complications during therapy. 73 Other neuroimaging abnormalities have also been described, such as increased subarachnoid spaces and cerebral atrophy.…”

The effect of unilateral stroke on autonomic function in the term newborn

“…We selected the MCA because it is by far the most common territory for neonatal stroke, and in the mature brain it is known to contain important cortical autonomic centers, including the insula. 5 The severity of MCA stroke was classified according to the previously validated Modified Pediatric ASPECT (Alberta stroke program early CT) score 6 based on the ability of this instrument to quantify childhood arterial ischemic stroke volumes. Higher scores (maximum of 15 points per hemisphere) indicate larger areas of infarction.…”