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Background and Aim Studies performed in infants with perinatal arterial ischemic stroke (PAIS) have shown relations between initial neuro-imaging and neurodevelopmental outcome. However, not all variation in outcome can be explained. It is known from adult stroke studies that (luxury) perfusion of the stroke area is related to outcome. In this study, Arterial Spin Labeling (ASL) MR imaging was used to evaluate (luxury) perfusion in infants with PAIS. Methods Conventional and ASL MR images (3T) were acquired of three PAIS patients 3–5 days after the ischemic event. Near Infrared Spectroscopy was used to monitor cerebral oxygenation. Follow-up MR imaging was conducted 2–16 weeks after the event. Results A lower perfusion signal was measured in all infants in the area corresponding with the diffusion-restricted area on the diffusion-weighted images. Furthermore, in one infant, luxury perfusion was visualised in the cortex of the affected area. Measurements of volume flow (Phase-Contrast MR Angiography) and cerebral oxygenation were in agreement with this, suggesting an ischemia-induced vasodilatation. Follow-up ASL MR images in this infant showed a partly recovered perfusion. Initial [fig. 1A] and follow-up ASL images [Fig. 1B] of this infant are shown. Conclusion Arterial Spin Labeling MR imaging can be used to evaluate (luxury) perfusion in the stroke area after PAIS. In the future, relations between ASL imaging findings and outcome should be drawn.

Background and aim Little is known about brain perfusion in neonates and its relation with brain development. The purpose of this study was to evaluate if Arterial Spin Labeling (ASL) Magnetic Resonance (MR) imaging can be used to evaluate the relation between brain perfusion and brain development. Methods Pulsed ASL-images (Philips-3T) were acquired of 31 infants. Six infants were imaged at preterm age, 23 infants at term equivalent age (TEA) and 2 infants at 3-months equivalent age (3m). Serial MR imaging was performed in 4 infants. Total brain perfusion (TBP) was measured for each infant. Regions of interest (ROIs) were drawn within the occipital cortex (OC), the frontal cortex (FC) and one ROI covered the basal ganglia and thalamus (BGT). Perfusion values measured in the ROIs were expressed relative toTBP. Results TBP increased from preterm age (7.1ml/100g.min) to TEA (12.6ml/100g.min) to 3m (30.2ml/100g.min). A relative decrease in perfusion towards the BGT and a relative increase towards the OC and FC was measured with increasing postconceptional age [fig 1]. Serial ASL images of one infant scanned at preterm [Fig.2a] and TEA [Fig.2B] are shown. Conclusions Arterial Spin Labeling MR images reflect the anatomical and functional maturation of the brain in neonates and are in agreement with previously obtained PET-images.