Abstract
Objective. To determine the significance of magnetic resonance angiography (MRA) of cerebral arteries in children with ischemic stroke and to evaluate the features of visualization of ischemia associated with pathological changes in blood vessels.
Material and methods. Magnetic resonance imaging in combination with MRA in the TOF (time of flight) mode was performed in 82 patients aged from 29 days of life to 18 years with neurological symptoms of cerebrovascular accident and with focal brain injury (BI). As a result of the analysis of 82 patients, two groups of examined children were distinguished: group 1 – patients with ischemic stroke (IS) associated with pathological changes in the arteries in the area of focal lesions (27 people), group 2 – patients without pathological changes in the cerebral arteries in the area of IS (55 human). A comparison was made of the localization, number and size of ischemic lesions in both groups. Intergroup comparisons were carried out quantitatively using the Mann–Whitney test, qualitatively using Fisher’s exact test. The value of 0.05 was used as the critical level of significance (p).
Results. MRA revealed vascular pathology in 50% (n=41) of cases, of which pathological changes in the arteries supplying the IS pool were noted in 66% (n=27) of patients in the form of stenosis, occlusion, dissection, in addition, in 12% (n=5) observations revealed aneurysms and arteriovenous malformations not associated with the pool of focal lesions. Ischemic stroke in the pool of which pathological changes in the vessels were detected was characterized by the presence of two or more foci of ischemia in 78% of cases (n=21, p=0.009), in addition, in 41% (n=11) of foci, changes were localized in the area of the basal ganglia, gray and white matter of the brain (p=0.008). Focal lesions with statistically significant largest transverse (p=0.006) and sagittal (p=0.0005) sizes were noted in the group of patients with pathological changes in the arteries feeding the pool with IS.
Conclusions. The presence of IS foci in the BI substance creates the need for MRA, which makes it possible to detect vascular pathology in 50% of cases. The most common forms of vascular pathology in IS are stenoses (22%), occlusions (11%) and dissections (2%), which were detected at the level of large calibers of the cerebral arteries supplying the pool with focal lesions. The combination of the presence of several IS foci, which have large lesions located in the region of the basal ganglia, gray and white matter of the brain, may be due to pathological changes in the vessels in the pool of which the changes were detected.
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About the authors
- Alexander P. Mazaev, Dr. Med. Sci., Radiologist; ORCID
- Maksim S. Molodtsov, Postgraduate, Radiologist; ORCID
- Svetlana P. Shchelykalina, Cand. Med. Sci., Associate Professor of Chair of Medical Cybernetics and Computer Science; ORCID
