TY - JOUR
T1 - Arteriopathy diagnosis in childhood arterial ischemic stroke
T2 - Results of the vascular effects of infection in pediatric stroke study
AU - Wintermark, Max
AU - Hills, Nancy K.
AU - DeVeber, Gabrielle A.
AU - Barkovich, A. James
AU - Elkind, Mitchell S V
AU - Sear, Katherine
AU - Zhu, Guangming
AU - Leiva-Salinas, Carlos
AU - Hou, Qinghua
AU - Dowling, Michael M.
AU - Bernard, Timothy J.
AU - Friedman, Neil R.
AU - Ichord, Rebecca N.
AU - Fullerton, Heather J.
AU - Benedict, S. L.
AU - Fox, C. K.
AU - Lo, W. D.
AU - Tan, M. A.
AU - Mackay, M. T.
AU - Kirton, A.
AU - Hernandez Chavez, M. I.
AU - Humphreys, P.
AU - Jordan, L. C.
AU - Sultan, S. M.
AU - Rivkin, M. J.
AU - Rafay, M. F.
AU - Titomanlio, L.
AU - Kovacevic, G. S.
AU - Yager, J. Y.
AU - Amlie-Lefond, C.
AU - Dlamini, N.
AU - Condie, J.
AU - Yeh, A.
AU - Kneen, R.
AU - Bjornson, B. H.
AU - Pergami, P.
AU - Zou, L. P.
AU - Elbers, J.
AU - Abdalla, A.
AU - Chan, A. K.
AU - Farooq, O.
AU - Lim, M. J.
AU - Carpenter, J. L.
AU - Pavlakis, S.
AU - Wong, V. C.
AU - Forsyth, R.
N1 - Publisher Copyright:
© 2014 American Heart Association, Inc.
PY - 2014/12/11
Y1 - 2014/12/11
N2 - Background and Purpose - Although arteriopathies are the most common cause of childhood arterial ischemic stroke, and the strongest predictor of recurrent stroke, they are difficult to diagnose. We studied the role of clinical data and follow-up imaging in diagnosing cerebral and cervical arteriopathy in children with arterial ischemic stroke.Methods - Vascular effects of infection in pediatric stroke, an international prospective study, enrolled 355 cases of arterial ischemic stroke (age, 29 days to 18 years) at 39 centers. A neuroradiologist and stroke neurologist independently reviewed vascular imaging of the brain (mandatory for inclusion) and neck to establish a diagnosis of arteriopathy (definite, possible, or absent) in 3 steps: (1) baseline imaging alone; (2) plus clinical data; (3) plus follow-up imaging. A 4-person committee, including a second neuroradiologist and stroke neurologist, adjudicated disagreements. Using the final diagnosis as the gold standard, we calculated the sensitivity and specificity of each step.Results - Cases were aged median 7.6 years (interquartile range, 2.8-14 years); 56% boys. The majority (52%) was previously healthy; 41% had follow-up vascular imaging. Only 56 (16%) required adjudication. The gold standard diagnosis was definite arteriopathy in 127 (36%), possible in 34 (9.6%), and absent in 194 (55%). Sensitivity was 79% at step 1, 90% at step 2, and 94% at step 3; specificity was high throughout (99%, 100%, and 100%), as was agreement between reviewers (=0.77, 0.81, and 0.78).Conclusions - Clinical data and follow-up imaging help, yet uncertainty in the diagnosis of childhood arteriopathy remains. This presents a challenge to better understanding the mechanisms underlying these arteriopathies and designing strategies for prevention of childhood arterial ischemic stroke.
AB - Background and Purpose - Although arteriopathies are the most common cause of childhood arterial ischemic stroke, and the strongest predictor of recurrent stroke, they are difficult to diagnose. We studied the role of clinical data and follow-up imaging in diagnosing cerebral and cervical arteriopathy in children with arterial ischemic stroke.Methods - Vascular effects of infection in pediatric stroke, an international prospective study, enrolled 355 cases of arterial ischemic stroke (age, 29 days to 18 years) at 39 centers. A neuroradiologist and stroke neurologist independently reviewed vascular imaging of the brain (mandatory for inclusion) and neck to establish a diagnosis of arteriopathy (definite, possible, or absent) in 3 steps: (1) baseline imaging alone; (2) plus clinical data; (3) plus follow-up imaging. A 4-person committee, including a second neuroradiologist and stroke neurologist, adjudicated disagreements. Using the final diagnosis as the gold standard, we calculated the sensitivity and specificity of each step.Results - Cases were aged median 7.6 years (interquartile range, 2.8-14 years); 56% boys. The majority (52%) was previously healthy; 41% had follow-up vascular imaging. Only 56 (16%) required adjudication. The gold standard diagnosis was definite arteriopathy in 127 (36%), possible in 34 (9.6%), and absent in 194 (55%). Sensitivity was 79% at step 1, 90% at step 2, and 94% at step 3; specificity was high throughout (99%, 100%, and 100%), as was agreement between reviewers (=0.77, 0.81, and 0.78).Conclusions - Clinical data and follow-up imaging help, yet uncertainty in the diagnosis of childhood arteriopathy remains. This presents a challenge to better understanding the mechanisms underlying these arteriopathies and designing strategies for prevention of childhood arterial ischemic stroke.
KW - Cerebral arterial diseases
KW - Pediatrics
KW - Stroke
KW - Transient ischemic attack
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UR - http://www.scopus.com/inward/citedby.url?scp=84923884892&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.114.007404
DO - 10.1161/STROKEAHA.114.007404
M3 - Article
C2 - 25388419
AN - SCOPUS:84923884892
SN - 0039-2499
VL - 45
SP - 3597
EP - 3605
JO - Stroke
JF - Stroke
IS - 12
ER -