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Voxel-based morphometry of brain MRI: first results in pediatric ischemic stroke cohort
While the outcomes of stroke in adults are relatively well-studied, our understanding of pediatric stroke remains limited. One of the key questions is how the characteristics of a stroke—such as its size and location—influence cognitive outcomes as children grow. In particular, extensive infarcts, widely linked to poor prognoses in adult stroke patients, have not been systematically explored in pediatric cases. Moreover, many studies fail to account for the age at which the stroke occurred in children, limiting the ability to differentiate between developmental impacts. To clarify the cognitive outcomes associated with the ischemic stroke in children, it is critical to quantitatively assess the characteristics of brain lesions in this population. This study focuses on describing infarct profiles in children (n = 35) who experienced ischemic stroke before the age of two. Using voxel-based morphometry, brain MRI data were analyzed to quantitatively describe structural lesions. The results showed that out of 35 cases, 48.6, 28.6, and 22.9% were left-hemispheric, right-hemispheric, and bilateral, respectively. Lesions involved the frontal lobe (n = 24, 68.6%) or parietal lobe (n = 19, 54.3%), with frequent involvement of the internal capsule (n = 22, 62.9%) and the middle cerebral artery territory (n = 33, 94.3%). The average lesion size was 20.1 mm3 (M = 20.1, MD = 28.4, SD = 393.4), accounting for approximately 3.4% of total brain volume (M = 3.4, MD = 0.3, SD = 6). The study also identified notable differences in the qualitative and quantitative characteristics of the infarcts depending on the timing of the stroke. Specifically, lesions differed between children with perinatal strokes (within the first 28 days of life) and those with pediatric strokes (occurring between 28 days and 2 years of age). Differences were also observed between children who had a stroke during the first year of life versus the second year. However, these distinctions were not statistically significant for the reduced sample with children with perinatal stroke excluded. Perinatal ischemic stroke was found to have unique features, with significantly larger lesions (M = 34.6, MD = 30.4, SD = 33.9) and higher lesion-to-brain volume ratios (M = 7.9, MD = 7.5, SD = 7.3). These findings suggest that perinatal stroke represents a distinct subgroup with a potentially elevated risk of long-term adverse outcomes. Overall, this detailed characterization of ischemic strokes in early childhood highlights the importance of considering the timing and nature of the infarct for the assessment of neurological and cognitive risks. The results establish a foundation for future research into the mechanisms of developmental compensation and the long-term impact of ischemic strokes in children.