AJNR. American journal of neuroradiology · 2026
Peri-Rolandic and Occipital Sparing Cortical Edema: A Prevalent MRI Finding in Pediatric Patients with Cerebral Malaria.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Vidal Lorenna, Zandifar Alireza, Kim Jorge Du Ub, Tierradentro-García Luis O, Heng Siyu, Meneses Marcus, Small Dylan, Chetcuti Karen, O'Brien Nicole, Postels Douglas, Taylor Terrie, Goyal Manu S
Аннотация
BACKGROUND AND PURPOSE: Cerebral malaria (CM) is a leading cause of childhood mortality and neurologic morbidity in sub-Saharan Africa and South Asia and a strong association between diffuse brain swelling and mortality has been well-established. Our goal was to characterize patterns of cortical edema on brain MRI in children with CM and determine their association with patient outcomes.
MATERIALS AND METHODS: We retrospectively reviewed admission brain MR images obtained from Malawian children with clinical CM admitted at a single center from 2013-2019. Two neuroradiologists assessed the pattern of cortical edema on T1-, T2-, and DWI by using a consensus approach. The overall degree of brain volume (brain volume score [BVS]) and other brain imaging findings were also assessed, including focal signal changes in the basal ganglia, white matter, and posterior fossa. We evaluated the frequency and associations of these imaging findings with clinical outcomes at hospital discharge (deceased, alive with neurologic sequelae, or alive without neurologic sequelae).
RESULTS: We included admission brain MRI scans from 190 children with clinical CM. Cortical edema was identified in 163 MRIs. The predominant pattern of cortical edema was diffuse cortical involvement with relative sparing of the occipital and peri-Rolandic areas: 103 (63.2%) had this pattern, whereas 37 (22.7%) had sparing of the occipital cortex only, and 23 (14.1%) had generalized cortical edema without focal sparing. The presence of occipital and peri-Rolandic sparing inversely correlated with BVS (β = -0.26, P < .001) and outcomes (OR: 0.3; 95% CI: 0.1-0.6; P = .002).
CONCLUSIONS: Pediatric CM is associated with a typical pattern of cortical edema that relatively spares the occipital and peri-Rolandic areas, which become progressively involved with more severe disease.
MATERIALS AND METHODS: We retrospectively reviewed admission brain MR images obtained from Malawian children with clinical CM admitted at a single center from 2013-2019. Two neuroradiologists assessed the pattern of cortical edema on T1-, T2-, and DWI by using a consensus approach. The overall degree of brain volume (brain volume score [BVS]) and other brain imaging findings were also assessed, including focal signal changes in the basal ganglia, white matter, and posterior fossa. We evaluated the frequency and associations of these imaging findings with clinical outcomes at hospital discharge (deceased, alive with neurologic sequelae, or alive without neurologic sequelae).
RESULTS: We included admission brain MRI scans from 190 children with clinical CM. Cortical edema was identified in 163 MRIs. The predominant pattern of cortical edema was diffuse cortical involvement with relative sparing of the occipital and peri-Rolandic areas: 103 (63.2%) had this pattern, whereas 37 (22.7%) had sparing of the occipital cortex only, and 23 (14.1%) had generalized cortical edema without focal sparing. The presence of occipital and peri-Rolandic sparing inversely correlated with BVS (β = -0.26, P < .001) and outcomes (OR: 0.3; 95% CI: 0.1-0.6; P = .002).
CONCLUSIONS: Pediatric CM is associated with a typical pattern of cortical edema that relatively spares the occipital and peri-Rolandic areas, which become progressively involved with more severe disease.