title: Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke.
abstract: Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome.
  
  
  
  We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome.
  
  
  
  This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5-14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging (b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann-Whitney test).
  
  
  
  Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes (p = 0.03). Corticospinal tract diaschisis was associated with motor outcome (p = 0.004). Method reliability was excellent.
  
  
  
  Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.
authors.affiliation: Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada adam.kirton@albertahealthservices.ca.
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.affiliation: Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Williams
authors.affiliation: Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Dowling
authors.affiliation: Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mah
authors.affiliation: Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Jacquie
authors.initials: J
authors.lastname: Hodge
authors.affiliation: Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Carlson
authors.affiliation: Department of Radiology, Alberta Children's Hospital, Calgary, AB, Canada.
authors.forename: Xing-Chang
authors.initials: XC
authors.lastname: Wei
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D009434:Neural Pathways / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012984:Software; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D054928:Validation Studies as Topic
keywords: Pediatric stroke; childhood stroke; diaschisis; diffusion imaging; diffusion-weighted imaging; magnetic resonance imaging