Perfusion abnormality on three-dimensional arterial spin labeling with a 3T MR system in pediatric and adolescent patients with migraine
Introduction
Migraine and its variants are common in children and adolescents. The prevalence of migraine have been reported to be 3.9% in children aged 3–7 years [1], 4.8% in Japanese junior high school students aged 12–15 years [2], and 15.6% in Japanese high school students aged 16–18 years [3]. In the pediatric population, migraine is a common headache syndrome, and about 30% of patients have migraine with aura [4]. The appearance of various symptoms in children makes the diagnosis of migraine with aura difficult.
The pathophysiology of migraine remains unclear, and conflicting theories with regard to vascular or neuronal dysfunction have been suggested. Recently, aura has been thought to be caused by a cortical spreading depression (CSD) associated with cerebral regional hypoperfusion accompanied by negative neurological features, and subsequent headache has been shown to be caused by neuronal hyperpolarization and dilatation of blood vessels [5].
Perfusion abnormalities associated with migraine have been demonstrated with nuclear medicine, CT, and dynamic susceptibility contrast MR perfusion studies [[6], [7], [8], [9], [10], [11], [12]]. However, these methods are limited in the evaluation of pediatric and adolescent patients with migraine because of their use in emergencies, radiation exposure, and contrast material use. In contrast, arterial spin labeling (ASL) is a noninvasive MRI method that can be used to measure cerebral perfusion [13,14]. The usefulness of ASL has been reported in various CNS disease such as posterior reversible encephalopathy syndrome [15], cranial dural arteriovenous fistula [16], and epilepsy [17]. Although ASL may be appropriate for the evaluation of cerebral perfusion in pediatric and adolescent patients with migraine, few studies have assessed the prevalence of perfusion abnormality with migraine [10,18].
The purpose of this study was to determine the prevalence, topography, and severity of perfusion abnormality on three-dimensional (3D) ASL at 3 T in pediatric and adolescent patients with migraine. Furthermore, the study compared clinical data and 3D ASL findings between patients with perfusion abnormality and those without perfusion abnormality.
Section snippets
Study population
All procedures followed the Clinical Study Guidelines of the Ethics Committee of Japanese Red Cross Kumamoto Hospital and were approved by the internal review board. The requirement of informed consent was waived.
The study enrolled 49 consecutive young patients (27 women and 22 men; age range, 3–18 years; mean age, 11 years) who were diagnosed with migraine and who subsequently underwent brain MRI, including 3D ASL from July 2015 to May 2016. Midazolam was administrated in 7 patients for
The prevalence, topography, severity and time interval change of perfusion abnormality
Among the 49 patients, 11 (22%) exhibited perfusion abnormality on 3D ASL. Fig. 2 shows the topography and grading of perfusion abnormality. The occipital lobe was most frequently involved (73%), followed by the parietal lobe (64%), frontal lobe (45%), temporal lobe (45%), and basal ganglia (27%). A single region was involved in two patients (18%), and multiple regions were involved in 9 patients (82%). Of the 11 patients with perfusion abnormality, 10 showed hypoperfusion (6 patients showed
Discussion
Our 3T-ASL study showed a high prevalence of perfusion abnormality in pediatric and adolescent migraine patients with or without aura. Parain et al. [22] demonstrated that SPECT showed hypoperfusion on day 1 and hyperperfusion on day 2 in pediatric patients with migraine aura lasting 1–24 h. Floery et al. [10] performed a DSC-MRI study and reported that hypoperfusion was found in 70% of patients with acute migrainous aura. Their study included patients who were suspected with acute cerebral
Formatting of funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Funding
Sources of funding for research and/or publication: none.
Ethical approval
We declare that all human studies have been approved by the Japanese Red Cross Kumamoto Hospital ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This retrospective study was approved by the ethics committee, and informed consent was waived. We presented a part of the contents of this paper at the 102th annual meeting of RSNA.
Conflict of interest
All authors declare no conflict of interest.
References (31)
- et al.
Prevalence and features of migraine in Japanese junior high school students aged 12-15 yr
Brain Dev.
(2007) - et al.
Acute intermittent porphyria presenting as posterior reversible encephalopathy syndrome with hyperperfusion in bilateral occipital lobes: A case report
J. Neurol. Sci.
(2017) - et al.
Usefulness of 3-Tesla magnetic resonance arterial spin-labeled imaging for diagnosis of cranial dural arteriovenous fistula
J. Neurol. Sci.
(2017) - et al.
Usefulness of arterial spin-labeling images in periictal state diagnosis of epilepsy
J. Neurol. Sci.
(2015) - et al.
Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management
Lancet Neurol.
(2011) - et al.
Stojadinovic Migraine in children-migraine syndrome in children of Vojvodina
Med. Arh.
(2010) - et al.
The prevalence and character of primary headache in Japanese high school students
Rinsho Shinkeigaku
(2005) - et al.
Child neurology: Migraine with aura in children
Neurology
(2010) Pathophysiology of the migraine aura. The spreading depression theory
Brain
(1994)- et al.
Familial hemiplegic migraine: follow-up findings of diffusion-weighted magnetic resonance imaging (MRI), perfusion-MRI and [99mTc] HMPAO-SPECT in a patient with prolonged hemiplegic aura
Cephalalgia
(2004)
Cerebral perfusion changes in hemiplegic migraine: illustrated by Tc-99m ECD brain perfusion scan
Clin. Nucl. Med.
Concurrent hemichorea and migrainous aura--a perfusion study on the basal ganglia using xenon-computed tomography
Mov. Disord.
A case of hemiplegic migraine in childhood: transient unilateral hyperperfusion revealed by perfusion MR imaging and MR angiography
AJNR Am. J. Neuroradiol.
Acute-onset migrainous aura mimicking acute stroke: MR perfusion imaging features
AJNR Am. J. Neuroradiol.
Magnetic resonance imaging arterial-spin-labelling perfusion alterations in childhood migraine with atypical aura: a case-control study
Dev. Med. Child Neurol.
Cited by (16)
Cortical excitability in migraine: Contributions of magnetic resonance imaging
2021, Revue NeurologiqueCitation Excerpt :This posterior cerebral hypoperfusion has been compared to that observed in migraine with aura. However, such observations remained rare and have not been well replicated: a study in a pediatric population using ASL MRI during a migraine attack showed that changes in cerebral perfusion were strongly correlated with the presence of an aura and that only five out of 41 patients with migraine without aura had changes in cerebral perfusion [21]. Another example is a study of 13 women scanned within the first 24 hours of a migraine without aura, which identified no changes in brain perfusion [22].
Hemispheric hypoperfusion during a first attack of migraine accompagnée
2021, Clinical Neurology and NeurosurgeryPerfusion abnormality on three-dimensional arterial spin labeling in patients with acute encephalopathy with biphasic seizures and late reduced diffusion
2020, Journal of the Neurological SciencesCitation Excerpt :Perfusion abnormality in AESD has been reported on single-photon emission computed tomography (SPECT) [8], but to the best of our knowledge, there are few case reports. Arterial spin labeling (ASL) is useful to evaluate cerebral perfusion in acute encephalitis [9], epilepsy [10,11], or migraine [12] non-invasively. ASL might be suitable for the evaluation of cerebral perfusion in pediatric emergency diseases because ASL does not involve radiation exposure or contrast material use [13].
Magnetic Resonance Imaging in Pediatric Migraine
2019, Canadian Journal of Neurological SciencesPerfusion imaging by arterial spin labeling in migraine: A literature review
2024, Journal of Cerebral Blood Flow and MetabolismArterial spin labeling MRI applied to migraine: current insights and future perspectives
2023, Journal of Headache and Pain