Study On The Risk Factors And Multimodal Magnetic Resonance Imaging Of Arterial Ischemic Cerebral Infarction In Children

Objective:Through retrospective analysis of clinical and MRI data of children with arterial ischemic cerebral infarction,to explore the risk factors of arterial ischemic cerebral infarction in children and newborns;summarize the characteristics of multimodal MRI,and preliminarily explore the application value of diffusion tensor imaging in the early evaluation of arterial ischemic cerebral infarction in children.Methods:From January 2016 to December 2019,0-15-year-old children(64 newborns aged 0-28 days,41 children aged more than 28 days and less than 15 years)who were hospitalized in the Department of Neurology and Neonatology of Shanxi Children’s Hospital for the first time were selected as the research objects.In a ratio of 1:2,children who were hospitalized during the same period but did not suffer from arterial ischemic cerebral infarction and had normal head magnetic resonance were selected as the control group.They were divided into children group and neonatal group.The clinical and magnetic resonance imaging data of all cases were collected and were retrospectively analyzed.All the enrolled cases completed routine MRI and DWI scans,and collected MRA and DTI scan data at the same time.For DTI scan cases,measure the FA value of the infarct site and the symmetry of the contralateral side and perform three-dimensional reconstruction of the white matter fiber bundles,observe the damage of the white matter fiber bundles on the affected side,and understand the normal white matter fiber bundles.The FA values of the infarct area and the healthy side symmetrical area were compared by independent sample t-test;the study group and the control group were compared by chi-square test and Fisher’s exact test;the collected related factors were analyzed by multivariate logistic regression analysis.Results:(1)Clinical manifestations: The main manifestation of the children group is limb weakness(31/41,75.6%),and there is a statistically significant difference with the control group in terms of limb weakness,skewed mouth angles,and nasolabial fold shallowing(P<0.05).The onset of convulsions was the most common in the neonatal group(40/64,62.5%),and there were statistically significant differences in convulsions,changes in muscle tone,poor response,gray complexion,bruising and fever from the control group(P<0.05).(2)Risk factors: Trauma(OR=9.820),moyamoya disease(OR=22.265),infection(OR=21.693)are risk factors for arterial ischemic cerebral infarction in children(P<0.05).Gestational age(OR=1.665),hypertension during pregnancy(OR=19.966),HIE(OR=6.098)and infection(OR=75.911)are the risk factors for neonatal arterial ischemic cerebral infarction(P<0.05).(3)MR results: Children and neonates have the same signal characteristics at each stage of cerebral infarction.In the neonatal group,21 cases of DWI showed a larger infarct range than T1 WI and T2 WI.12 cases of acute stage neonates had shorter cerebral gyrus-like T1 and shorter T2 signals.The sequelae of follow-up MR were mainly the formation of softening foci;2 cases of new infarction in the child group.There were significant differences between the two groups of infarcts in the basal ganglia,lateral ventricle,brain lobe,dorsal thalamus,corpus callosum and internal capsule(P<0.05).MRA showed that the middle cerebral artery was most commonly involved,and the difference between the two groups was not statistically significant(P>0.05);there were statistically significant differences between children and newborns in terms of internal carotid artery involvement,multiple tortuous angiograms,and rich branches of blood vessels(P<0.05).In the children group,8 cases of DTI showed destruction of white matter fiber bundles in 6 cases and no obvious abnormalities in 2 cases;the FA value of 8 cases in the infarct area was lower than that in the symmetry area of the healthy side,and the difference was statistically significant(t=-9.007,P<0.05).Conclusion:(1)The risk factors for arterial ischemic cerebral infarction in children are diverse.Children include trauma,moyamoya disease,and infection.Newborns include gestational age,hypertension during pregnancy,hypoxic-ischemic encephalopathy,and infections.(2)The characteristics of the MR signal of cerebral infarction are different in different periods.The middle cerebral artery is the most common responsible vessel.DWI shows the range of the lesion better than the conventional sequence.The sequelae of the infarct lesions are mainly manifested by the formation of softening lesions;the FA value of the infarct area is significantly lower than that of the symmetrical area on the healthy side.DTI is of great significance for the early evaluation of white matter fiber tract damage in children with arterial ischemic cerebral infarction.