UCSF PEDIATRIC STROKE IMAGING PROTOCOLS
Pediatric Stroke MRI Protocol
Clinical indication:
 Suspected hyperacute ischemic stroke in a child 14 years of age or younger
 Suspected ischemic stroke that is NOT hyperacute in a child of any age
Requisition should read (1 basic request and 3 options depending on the clinical scenario):
“pediatric stroke MRI” (to order core protocol)
± “suspicion of dissection” (to add options 6 & 7)
± “suspicion of venous thrombosis” (to add option 8)
± “perfusion imaging” (to add option 9)
Clinical notes (for child neurology service):
 For hyperacute stroke protocol (consideration of IV/IA tPA or embolectomy):
o order core protocol only
o consider attempting w/o anesthesia if patient might hold still for 10 minutes
with support of family
o add “suspicion of dissection” only if high suspicion of cervical dissection and
concern that this could alter decisions regarding hyperacute therapy (this will
lengthen time of study)
 For routine stroke protocol (no issues regarding time)
o order core protocol and “suspicion of dissection” (all first pediatric strokes
should have cervical vascular imaging as part of their evaluation) and
“perfusion imaging”
o add “suspicion of venous thrombosis” if venous infarct is suspected/likely
Core Pediatric Stroke MRI Protocol
1.
Axial Diffusion of the brain
(slice thickness: 3mm, gap: 1mm)
2.
Coronal Diffusion of the brain
(slice thickness: 3mm, gap: 1mm)
3a.
3b.
Axial FLAIR of the brain (if 1 year old or older)
Axial TSE T2 for children less than 1 year old
(slice thickness: 3mm, gap: 1mm)
4.
TOF MRA of the intracranial vessels
5.
Axial MPGR of the brain
(slice thickness: 3mm, gap: 1mm)
Optional Pediatric Stroke MRI Protocol
if dissection is suspected:
option 6. Axial T1 fat sat of the neck
option 7. TOF MRA of the neck vessels
if venous thrombosis is suspected:
option 8. TOF MRV of the intracranial veins/sinuses
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perfusion MR imaging:
option 9. axial perfusion imaging of the brain (requires the injection of contrast,
0.1 mmol/kg chased by 0.1 cc/kg of saline,
injection rate: 2 cc/sec between 1-10 years and 4 cc/sec between 10-18 years)
Pediatric Stroke CT Protocol
Clinical indication:
 Suspected hyperacute ischemic stroke in a child 15 years of age or older
 Suspected ischemic stroke in a child who cannot receive MRI (e.g.,
pacemaker, clinical instability) and risks of radiation are acceptable given
clinical scenario
Requisition should read (1 basic request and 3 options depending on the clinical scenario):
“pediatric stroke CT” (to order core protocol)
± “perfusion imaging” (to add option 2)
± “intracranial CTA” (to add option 3)
± “cervical and intracranial CTA” (to add option 4)
Clinical notes (for child neurology service):
 For hyperacute stroke protocol (consideration of IV/IA tPA or embolectomy):
o order core protocol, perfusion imaging, and intracranial CTA
o add “cervical CTA” only if high suspicion of cervical dissection and concern
that this could alter decisions regarding hyperacute therapy (this exposes the
thyroid to radiation)
 For routine stroke protocol (no issues regarding time)
o order MRI unless contraindicated
o if contraindications to MRI, and radiation risks are acceptable, order core
protocol and all options
Core Pediatric Stroke CT Protocol
1.
Noncontrast CT of the brain
(slice thickness: 2.5mm, reconstruction interval: 2.5mm, pitch as close to 1 as
possible, rotation time: 1 sec, noise index 4, min-max mA: 50-300, 120 kVp)
Optional Pediatric Stroke MRI Protocol
option 2.
1 single Perfusion-CT series according to dedicated pediatric protocol
Perfuson-CT protocols
1-10 years
10-18 years
acquisition parameters
80 kVp
80 mAs
80 kVp
100 mAs
duration of the CT acquisition
35 sec
40 sec
every 1 sec
every 1 sec
CT image sampling rate
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Rev. 7/23/2008
total number of images per level
35 images
40 images
1 cc/kg
1 cc/kg
saline chase
0.1 cc/kg
0.1 cc/kg
injection rate
2 cc/sec
4 cc/sec
5 sec
5 sec
amount of contrast material
for the bolus
delay between beginning of
intravenous administration
of contrast material and
data acquisition °
option 3.
CTA of the intracranial vessels
(slice thickness: 1.25mm, reconstruction interval: 1mm, pitch as close to 1 as
possible, rotation time: 0.4 sec, noise index 4, min-max mA: 100-300, 100 kVp,
1.5 cc/kg of contrast chased by 0.1 cc/kg of saline,
same injection rate as for PCT)
option 4.
extension of the CTA acquisition to the level of the clavicles
(NOT to include the aortic arch or the heart)
5.
post-contrast CT of the brain
ALWAYS TO BE OBTAINED IF CONTRAST MATERIAL IS INJECTED
(slice thickness: 2.5mm, reconstruction interval: 2.5mm, pitch as close to 1 as
possible, rotation time: 1 sec, noise index 4, min-max mA: 50-300)
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