Neuroimaging Advances in Pediatric Stroke

Manus J. Donahue, PhD; Nomazulu Dlamini, MD, PhD; Aashim Bhatia, MD, MS; Lori C. Jordan, MD, PhD


Stroke. 2019;50(2):240-248. 

In This Article

Abstract and Introduction


When a child has stroke-like symptoms, critical issues must be addressed, including confirmation of stroke rather than a stroke mimic, stroke pathogenesis, pathophysiology of the injury, and evaluation of recovery potential. During the next decade, technological advances will enable improved monitoring and personalized therapy in multiple stages of cerebrovascular disease, including stroke prevention, acute stroke, and poststroke rehabilitation. Neuroimaging will likely play a central role in each area, and the emphasis of new neuroimaging avenues will not only focus on mapping the topography of prior tissue damage but expand to include molecular and hemodynamic biomarkers that may be used to triage patients for preventative therapies and optimize these therapies by quantifying their impact on tissue function and health.

Computed tomographic (CT) perfusion, positron emission tomography, and magnetic resonance imaging (MRI) are relevant for characterizing functional tissue profiles; however, MRI is particularly appealing in pediatric patients because of the ability to sequentially visualize soft tissue, vasculature, and quantitative hemometabolic markers of ischemia without ionizing radiation. This review focuses on clinical questions that may be answered with advanced neuroimaging in children with suspected stroke and highlights how quantitative, noninvasive imaging may be used to expand the pediatric stroke imaging landscape.