Morphometric analysis of MRI images in children who suffered an ischemic stroke under the age of two years: a pilot study
DOI:
https://doi.org/10.54878/pys08a48Keywords:
MRI, brain morphometry, cognitive development, prognostic biomarkersAbstract
Morphometric evaluation of MRI images can provide important information about the exact lesion size and its localization in the brain, can guide therapeutic tactics and predict outcomes. At the same time, there are few relevant studies on morphometry in pediatric cohorts and its relationship to outcome data in the remote period of the disease. The aim of the present study is to establish morphometric characteristics of cerebral infarction in the acute period of the disease in a pediatric cohort of patients within a pilot study for further assessment of neural tissue recovery variants and comparison with cognitive function deficits in the residual period. Materials and Methods. The present work was prepared as part of the Psychological Dictionary Research Award competition and focuses on the first data from the morphometric analysis. An extended version of the clinical cohort including children from this study is presented in the published article “Voxel-based morphometry of brain MRI: first results in pediatric ischemic stroke cohort” (Korotkova et al., 2025). We analyzed brain MRI images obtained in the acute period of ischemic stroke in 21 children with the disease debut at the age of up to two years using software (RadiAnt DICOM Viewer, MRIcron, BrainVISA / Anatomist). Results: Qualitative and quantitative analysis revealed a predominance of left hemispheric (n = 10, 48%) middle cerebral artery pool (n = 19, 90%), subcortical localization (n = 15, 71%) with involvement of the internal capsule (n = 13, 62%). The volume of the infarct focus in the experimental sample varied significantly from 409 to 102192 mm3 (median - 2841 mm3) and occupied on average 2.9% of the total brain volume. The average lesion volume was significantly larger in the perinatal stroke group compared with the pediatric stroke group (10.4% vs 1.2%). Thus, brain regions considered important for future neurocognitive and motor development (internal capsule and thalamus) were involved in the ischemic infarct zone in more than half of cases (62%), which defines the importance of pilot morphometric MRI studies in studying the volume and localization of infarcts in young children.
References
Abiodun, A. (2018). Stroke (Cerebrovascular Accident (CVA) or Brain Attack) and Its Management – Literature Review. International Journal of Innovative Healthcare Research, 6, 1¬¬¬–9.
Al Harrach, M., Rousseau, F., Groeschel, S., Wang, X., Hertz-Pannier, L., Chabrier, S., Bohi, A., Lefevre, J., Dinomais, M., & AVCnn group (2019). Alterations in Cortical Morphology after Neonatal Stroke: Compensation in the Contralesional Hemisphere?. Developmental neurobiology, 79(4), 303–316. https://doi.org/10.1002/dneu.22679
Alhajeri, N. (2024). Interactive GUI for Advanced Visualization and Volume Rendering of MRI Data: A MATLAB – Based Approach. International Journal of Applied Technology in Medical Sciences, 3(1), 17-25. https://doi.org/10.54878/rxzd0j10
Arachchige, P. R. W., Karunarathna, S., Wataru, U., Ryo, U., Median, A. C., Yao, D. P., Abo, M., & Senoo, A. (2021). Changes in brain morphometry after motor rehabilitation in chronic stroke. Somatosensory & motor research, 38(4), 277–286. https://doi.org/10.1080/08990220.2021.1968369
Ashburner, J., & Friston, K. J. (2000). Voxel-based morphometry--the methods. NeuroImage, 11(6 Pt 1), 805–821. https://doi.org/10.1006/nimg.2000.0582
Bulanov, N.М., Suvorov, A.Yu., Blyuss, O.B., Munblit, D.B., Butnaru, D.V., Nadinskaia, M.Yu., Zaikin, A.A. (2021). Basic principles of descriptive statistics in medical research. Sechenov Medical Journal, 12(3): 4–16. https://doi.org/10.47093/2218-7332.2021.12.3.4-16
Chalavi, S., Simmons, A., Dijkstra, H., Barker, G. J., & Reinders, A. A. (2012). Quantitative and qualitative assessment of structural magnetic resonance imaging data in a two-center study. BMC medical imaging, 12, 27. https://doi.org/10.1186/1471-2342-12-27
Corbetta, M., Ramsey, L., Callejas, A., Baldassarre, A., Hacker, C. D., Siegel, J. S., Astafiev, S. V., Rengachary, J., Zinn, K., Lang, C. E., Connor, L. T., Fucetola, R., Strube, M., Carter, A. R., & Shulman, G. L. (2015). Common behavioral clusters and subcortical anatomy in stroke. Neuron, 85(5), 927–941. https://doi.org/10.1016/j.neuron.2015.02.027
Craig, B. T., Hilderley, A., Kirton, A., & Carlson, H. L. (2021). Imaging Developmental and Interventional Plasticity Following Perinatal Stroke. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 48(2), 157–171. https://doi.org/10.1017/cjn.2020.166
Dinomais, M., Hertz-Pannier, L., Groeschel, S., Chabrier, S., Delion, M., Husson, B., Kossorotoff, M., Renaud, C., Nguyen The Tich, S., & AVCnn Study Group (2015). Long term motor function after neonatal stroke: Lesion localization above all. Human brain mapping, 36(12), 4793–4807. https://doi.org/10.1002/hbm.22950
Dinomais, M., Hertz-Pannier, L., Groeschel, S., Delion, M., Husson, B., Kossorotoff, M., Renaud, C., Chabrier, S., The Tich, S. N., & AVCnn Study Group (2016). Does Contralesional Hand Function After Neonatal Stroke Only Depend on Lesion Characteristics?. Stroke, 47(6), 1647–1650. https://doi.org/10.1161/STROKEAHA.116.013545
Dunbar, M., & Kirton, A. (2018). Perinatal stroke: mechanisms, management, and outcomes of early cerebrovascular brain injury. The Lancet. Child & adolescent health, 2(9), 666–676. https://doi.org/10.1016/S2352-4642(18)30173-1
Emos, M. C., Khan Suheb, M. Z., & Agarwal, S. (2023). Neuroanatomy, Internal Capsule. In StatPearls. StatPearls Publishing.
Geffroy, D., Rivière D., Denghien I., Souedet N., Laguitton S., Cointepas Y. (2011). BrainVISA: a complete software platform for neuroimaging, In Python in Neuroscience workshop, Paris.
Goldman-Yassen, A. E., & Dehkharghani, S. (2021). Neuroimaging in Pediatric Stroke and Cerebrovascular Disease. In S. Dehkharghani (Ed.), Stroke. Exon Publications.
Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Retrieved March 21, 2025, from https://vizhub.healthdata.org/
Jordan, L. C., & Hillis, A. E. (2011). Challenges in the diagnosis and treatment of pediatric stroke. Nature reviews. Neurology, 7(4), 199–208. https://doi.org/10.1038/nrneurol.2011.23
Khalaf, A., Iv, M., Fullerton, H., & Wintermark, M. (2018). Pediatric Stroke Imaging. Pediatric neurology, 86, 5–18.
Kong, X. Z., Mathias, S. R., Guadalupe, T., ENIGMA Laterality Working Group, Glahn, D. C., Franke, B., Crivello, F., Tzourio-Mazoyer, N., Fisher, S. E., Thompson, P. M., & Francks, C. (2018). Mapping cortical brain asymmetry in 17,141 healthy individuals worldwide via the ENIGMA Consortium. Proceedings of the National Academy of Sciences of the United States of America, 115(22), E5154–E5163. https://doi.org/10.1073/pnas.1718418115
Korotkova, E.V., Kulikova, S.P., Kotyusov, A.I., Kunnikova, K.I., Kleeva, D.F., Lebedev, M.A., Lvova, O.A. (2025). Voxel-based morphometry of brain MRI: first results in pediatric ischemic stroke cohort. Neuroscience and Behavioral Physiology, 55(2), 327–339. https://doi.org/10.1007/s11055-025-01755-6
Lehman, L. L., & Rivkin, M. J. (2014). Perinatal arterial ischemic stroke: presentation, risk factors, evaluation, and outcome. Pediatric neurology, 51(6), 760–768. https://doi.org/10.1016/j.pediatrneurol.2014.07.031
Li, E., Smithson, L., Khan, M., Kirton, A., Pei, J., Andersen, J., Yager, J. Y., Brooks, B. L., & Rasmussen, C. (2022). Effects of Perinatal Stroke on Executive Functioning and Mathematics Performance in Children. Journal of child neurology, 37(2), 133–140. https://doi.org/10.1177/08830738211063683
Malone, L. A., Levy, T. J., Peterson, R. K., Felling, R. J., & Beslow, L. A. (2022). Neurological and Functional Outcomes after Pediatric Stroke. Seminars in pediatric neurology, 44, 100991. https://doi.org/10.1016/j.spen.2022.100991
McKinney, S. M., Magruder, J. T., & Abramo, T. J. (2018). An Update on Pediatric Stroke Protocol. Pediatric emergency care, 34(11), 810–815. https://doi.org/10.1097/PEC.0000000000001653
Nukovic, J. J., Opancina, V., Ciceri, E., Muto, M., Zdravkovic, N., Altin, A., Altaysoy, P., Kastelic, R., Velazquez Mendivil, D. M., Nukovic, J. A., Markovic, N. V., Opancina, M., Prodanovic, T., Nukovic, M., Kostic, J., & Prodanovic, N. (2023). Neuroimaging Modalities Used for Ischemic Stroke Diagnosis and Monitoring. Medicina (Kaunas, Lithuania), 59(11), 1908. https://doi.org/10.3390/medicina59111908
Ospel, J. M., Rinkel, L., Ganesh, A., Demchuk, A., Joshi, M., Poppe, A., McTaggart, R., Nogueira, R., Menon, B., Tymianski, M., Hill, M. D., & Goyal, M. (2024). Influence of Infarct Morphology and Patterns on Cognitive Outcomes After Endovascular Thrombectomy. Stroke, 55(5), 1349–1358. https://doi.org/10.1161/STROKEAHA.123.045825
Postic, P. Y., Leprince, Y., Brosset, S., Drutel, L., Peyric, E., Ben Abdallah, I., Bekha, D., Neumane, S., Duchesnay, E., Dinomais, M., Chevignard, M., & Hertz-Pannier, L. (2024). Brain growth until adolescence after a neonatal focal injury: sex related differences beyond lesion effect. Frontiers in neuroscience, 18, 1405381. https://doi.org/10.3389/fnins.2024.1405381
Rebsamen, M., Suter, Y., Wiest, R., Reyes, M., & Rummel, C. (2020). Brain Morphometry Estimation: From Hours to Seconds Using Deep Learning. Frontiers in neurology, 11, 244. https://doi.org/10.3389/fneur.2020.00244
Royal College of Paediatrics and Child Health. (2017). Stroke in childhood –clinical guideline for diagnosis, management and rehabilitation. Retrieved April 3, 2025, from https://www.rcpch.ac.uk/resources/stroke-in-childhood-clinical-guideline
Sarecka-Hujar, B., & Kopyta, I. (2020). Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults. Brain sciences, 10(1), 24. https://doi.org/10.3390/brainsci10010024
Schnaufer, L., Gschaidmeier, A., Heimgärtner, M., Driever, P. H., Hauser, T. K., Wilke, M., Lidzba, K., & Staudt, M. (2024). Atypical language organization following perinatal infarctions of the left hemisphere is associated with structural changes in right-hemispheric grey matter. Developmental
medicine and child neurology, 66(3), 353–361. https://doi.org/10.1111/dmcn.15751
Steiner, L., Federspiel, A., Jaros, J., Slavova, N., Wiest, R., Steinlin, M., Grunt, S., & Everts, R. (2021). Cerebral blood flow and cognitive outcome after pediatric stroke in the middle cerebral artery. Scientific reports, 11(1), 19421. https://doi.org/10.1038/s41598-021-98309-w
Sun, H. (2025). Advancements in Clinical Trial Methodologies: A Century in Review. International Journal of Applied Technology in Medical Sciences, 4(1), 10–17.
Tan, M. A., Layug, E. J. V., Singh, B. P., & Parakh, M. (2022). Diagnosis of Pediatric Stroke in Resource Limited Settings. Seminars in pediatric neurology, 44, 100997. https://doi.org/10.1016/j.spen.2022.100997
Tedyanto, E. H., Tini, K., & Pramana, N. A. K. (2022). Magnetic Resonance Imaging in Acute Ischemic Stroke. Cureus, 14(7), e27224. https://doi.org/10.7759/cureus.27224
Westmacott, R., Askalan, R., MacGregor, D., Anderson, P., & Deveber, G. (2010). Cognitive outcome following unilateral arterial ischaemic stroke in childhood: effects of age at stroke and lesion location. Developmental medicine and child neurology, 52(4), 386–393. https://doi.org/10.1111/j.1469-8749.2009.03403.x
Yamadori, A., Ohkawa, S., Mori, E. (1995). Behavioral Syndromes in Early Right Middle Cerebral Artery Territory Stroke. In: Yamaguchi, T., Mori, E., Minematsu, K., del Zoppo, G.J. (eds) Thrombolytic Therapy in Acute Ischemic Stroke III. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68459-6_11
Zayed Higher Organization for People of Determination (UAE) & Ural Federal University. (2024). Emirati-Russian psychological encyclopedic dictionary. Retrieved May, 7, from https://psychologydictionary.ae/ru/
Zhao, L., Biesbroek, J. M., Shi, L., Liu, W., Kuijf, H. J., Chu, W. W., Abrigo, J. M., Lee, R. K., Leung, T. W., Lau, A. Y., Biessels, G. J., Mok, V., & Wong, A. (2018). Strategic infarct location for post-stroke cognitive impairment: A multivariate lesion-symptom mapping study. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 38(8), 1299–1311. https://doi.org/10.1177/0271678X17728162
