Idiopathic ischemic cerebral infarction in childhood: Depiction of arterial abnormalities by MR angiography and catheter angiography

BACKGROUND AND PURPOSE: We report our experience with MR imaging, MR angiog raphy, and catheter angiography in children with acute idiopathic cerebral infarction and suggest that catheter angiography may still play an importan t role in this setting. METHODS: During the past 8 years, 18 children with idiopathic cerebral infa rction underwent MR imaging and catheter angiography; 17 were also studied with MR angiography, MR imaging was done within 34 hours after onset of hem iplegia or seizures or both. Sixteen patients underwent catheter angiograph y within 36 hours of MR imaging; 12 studies were performed within 22 hours. Two patients underwent catheter angiography, in both cases within 72 hours . Infarcts were compared with arterial abnormalities seen at catheter angio graphy, and the results of MR angiography were compared with those seen at catheter angiography, RESULTS: Comparing MR angiography with catheter angiography, we found the p ositive predictive value of MR angiography for arteriopathy was 100%, with a negative predictive value of 88%, MR angiography was equivalent to cathet er angiography in the detection and depiction of proximal middle cerebral a rtery disease; however, depiction of disease in the internal carotid artery (ICA) and detection of peripheral embolic disease were better with cathete r angiography than MR angiography, CONCLUSION: Basal ganglia lesions associated with ICA disease by MR angiogr aphy should probably be studied with digital subtraction angiography, as MR angiography did not depict the length and severity of ICA disease as well as catheter angiography did. Hemispheric infarcts should be studied with ca theter angiography, as emboli may occur in the absence of heart disease; th e circle of Willis may be uninvolved with embolic disease, and MR angiograp hy is not sensitive to emboli in small peripheral intracranial arteries.