title: Evolution of unilateral perinatal arterial ischemic stroke on conventional and diffusion-weighted MR imaging.
abstract: OBJECTIVE
  Knowledge of the sequence of signal-intensity (SI) changes on conventional and diffusion-weighted MR imaging (DWI) following perinatal arterial ischemic stroke (PAIS) is limited, adding to the difficulty in timing the onset of PAIS. We hypothesized that SI changes seen on early sequential MR imaging following PAIS should follow a similar time course. The aim of this study was to evaluate the time course of SI changes by using a simple classification that could be assessed visually from conventional imaging and DWI in term-born neonates with symptomatic unilateral PAIS.
  
  
  METHODS
  Infants > or =36 weeks gestation with unilateral PAIS in the territory of a main cerebral artery with a first MR imaging performed within the first postnatal month were included in this study. All subsequent scans up to 3 months postnatal age were also evaluated. For the conventional MR imaging scans, a visual SI scoring system was used (-1 = lower, 0 = equal, 1 = higher) compared with the contralesional hemisphere. For the DWIs, SI of the infarcted tissue was classified into the 3 groups: 1) severe hyperintensity (HI), 2) moderate and mild HI, and 3) no HI.
  
  
  RESULTS
  We analyzed 43 scans (mean age at first scanning, 4 days) from 21 term infants. Changes in SI on conventional T1 and T2 images were remarkably consistent among infants. The cortex was of low SI on T1 and high SI on T2 until day 6 when SIs reversed and cortical highlighting was seen for 1-2 months. The white matter was high SI on T1 in the first 8-9 days and on T2 for >2 weeks before becoming low SI. Secondary SI changes remote from the infarction were seen in the thalamus and brain stem in the first week, and atrophy was seen after 4 weeks. All DWIs showed high SI of the affected region until at least day 4, which fell to equal or below that of the contralesional hemisphere by day 12.
  
  
  CONCLUSIONS
  The pattern of SI change on conventional imaging and DWI following PAIS was remarkably consistent among patients, suggesting that PAIS in symptomatic term-born infants occurs within a very limited timeframe around birth.
authors.affiliation: Robert Steiner MR Unit, Imaging Sciences Department, Medical Research Council Clinical Sciences Centre, Hammersmith Campus, Imperial College London, UK. j.dudink@ erasmusmc.nl
authors.forename: J
authors.initials: J
authors.lastname: Dudink
authors.forename: E
authors.initials: E
authors.lastname: Mercuri
authors.forename: L
authors.initials: L
authors.lastname: Al-Nakib
authors.forename: P
authors.initials: P
authors.lastname: Govaert
authors.forename: S J
authors.initials: SJ
authors.lastname: Counsell
authors.forename: M A
authors.initials: MA
authors.lastname: Rutherford
authors.forename: F M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*