Arteriopathy diagnosis in childhood arterial ischemic stroke: results of the vascular effects of infection in pediatric stroke study.
Arteriopathy diagnosis in childhood arterial ischemic stroke: results of the vascular effects of infection in pediatric stroke study.
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DOI：
10.1161/strokeaha.114.007404
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发表时间：
2014-12
期刊：
影响因子：
8.3
通讯作者：
VIPS Investigators
中科院分区：
文献类型：
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作者：
Wintermark M;Hills NK;deVeber GA;Barkovich AJ;Elkind MS;Sear K;Zhu G;Leiva-Salinas C;Hou Q;Dowling MM;Bernard TJ;Friedman NR;Ichord RN;Fullerton HJ;VIPS Investigators
尽管动脉病是儿童动脉缺血性中风 (AIS) 的最常见原因，也是中风复发的最强预测因素，但它们很难诊断。我们研究了临床数据和随访影像学在诊断 AIS 儿童脑动脉和颈动脉病中的作用。 VIPS 是一项国际前瞻性研究，在 39 个中心招募了 355 例 AIS 病例（年龄 29 岁至 18 岁）。神经放射科医生和中风神经科医生独立审查了大脑（强制纳入）和颈部的血管成像，以通过 3 个步骤确定动脉病（明确的、可能的或不存在）的诊断：（1）单独基线成像； (2)加上临床数据； (3)加随访影像学检查。一个四人委员会（包括第二位神经放射科医生和中风神经科医生）对分歧做出了裁决。使用最终诊断作为金标准，我们计算了每个步骤的敏感性和特异性。病例中位年龄为 7.6 岁（IQR 2.8, 14）； 56%为男性。大多数人 (52%) 以前身体健康； 41% 进行了后续血管成像检查。只有 56 人 (16%) 需要裁决。金标准诊断为 127 例 (36%) 明确患有动脉病，34 例 (9.6%) 可能患有动脉病，194 例 (55%) 不存在动脉病。步骤 1 的灵敏度为 79%，步骤 2 的灵敏度为 90%，步骤 3 的灵敏度为 94%；特异性始终很高（99%、100%、100%），审稿人之间也达成一致（Kappa 0.77、0.81、0.78）。临床数据和随访影像学有所帮助，但儿童动脉病的诊断仍然存在不确定性。这对更好地理解这些动脉病的机制和设计预防儿童 AIS 的策略提出了挑战。
Although arteriopathies are the most common cause of childhood arterial ischemic stroke (AIS), 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 AIS. VIPS, an international prospective study, enrolled 355 cases of AIS (age 29d-18y) 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. Cases were median 7.6 years of age (IQR 2.8, 14); 56% male. The majority (52%) were 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%, 100%), as was agreement between reviewers (Kappa 0.77, 0.81, 0.78). 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 AIS.