Idiopathic Ischemic Cerebral Infarction in Childhood: Depiction of Arterial Abnormalities by MR Angiography and Catheter Angiography
Nancy Rollins,a,
Michael Dowlinga,
Timothy Bootha and
Phillip Purdya
a From the Departments of Radiology (N.R., T.B., P.P.) and Pediatric Neurology (M.D.), Children's Medical Center and University of Texas Southwestern Medical Center, Dallas.
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FIG 1. Patient 8: 4-year-old boy with right hemiparesis. This case illustrates the typical location of MCA stenosis associated with basal ganglia infarction.
A, Axial proton density–weighted image shows infarct in the left putamen.
B, Coronal MIP from 3D TOF MR angiography (0.5 T) shows stenoses (arrows) at the M1-M2 junction.
C, Stenoses of the left MCA (arrows) correspond in location to those seen at MR angiography. The angiographically more severe lesion is associated with a longer area of dephasing on the MR angiogram. There was no change in the arterial disease at repeat DSA 6 months later.
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FIG 2. Patient 6: 13-year-old girl with carotid occlusion associated with basal ganglia infarction. This case illustrates the insensitivity of MR angiography to distal carotid occlusion when flow through the circle of Willis is intact. By MR angiography, the right ICA was patent and the MCA was small.
A, Proton density–weighted image shows infarct of the right putamen.
B, Axial MIP from 3D TOF MR angiography (0.5 T) shows small-caliber right MCA and A1 segments, suggesting disease in both vessels. The right ICA appears patent but was actually occluded at DSA.
C, DSA shows abrupt occlusion of a small-caliber ICA at the level of the ophthalmic artery. The MCA and A1 segments were normal with injection of the left ICA.
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FIG 3. Patient 4: 15-year-old girl with left hemiparesis. In this case, carotid occlusive disease could not be distinguished from stenosis, and the extent and severity of occlusive disease were overestimated by MR angiography.
A, Axial proton density–weighted image shows watershed infarcts.
B, Coronal MIP from MR angiography acquired at 0.5 T provides poor delineation of the circle of Willis and ICA.
C, Anteroposterior projection shows supraclinoid ICA is of smaller caliber than the A1 and M1 segments, indicating stenosis. The left ICA was occluded.
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FIG 4. Patient 10: 6-year-old boy with right hemiparesis that resolved over 6 days. In this case, ICA dissection was associated with questionable narrowing of the MCA.
A, Coronal MIP from 3D TOF MR angiography shows small-caliber low signal intensity in the left ICA (arrow), indicating slow flow.
B, Left common carotid angiogram shows dissection of the left cervical carotid artery, which terminates at the level of the ophthalmic artery.
C, Right ICA angiogram shows subtle stenosis or spasm of the left MCA (arrow), which was not perceived at MR angiography. Follow-up angiography was not performed.
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FIG 5. Patient 13: 5-year-old boy with right hemiparesis. This case illustrates overestimation of ICA stenosis by MR angiography as compared with DSA.
A, T2-weighted MR image shows infarct in left putamen (arrows).
B, Coronal MIP from 3D TOF MR angiography shows narrowed left ICA (straight arrow). Apparent narrowing of left MCA (curved arrow) is a reconstruction artifact that was not present on the axial source or multiplanar reformatted images.
C, Selective left ICA injection done 17 hours after MR angiography shows apparent concentric narrowing (possibly spasm) of the supraclinoid ICA. The MCA was normal.
D, Lateral view of the right ICA is shown for comparison. Note the caliber of the supraclinoid ICA.
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