rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2025-28-5-329-336cxkrglrosped-1821Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESМагнитно-резонансная томография в диагностике геморрагических инсультов у детейMagnetic resonance imaging in the diagnosis of hemorrhagic strokes in childrenhttps://orcid.org/0000-0002-3235-8854АхадовТолибджон АбдуллаевичAkhadovTolibdzhon A.

Доктор мед. наук, проф., руководитель отдела лучевых методов диагностики, ГБУЗ «НИИ НДХиТ — Клиника доктора Рошаля» ДЗМ

e-mail: akhadov@mail.ru

akhadov@mail.ruhttps://orcid.org/0000-0002-4627-9874УблинскийМаксим ВадимовичUblinskiyMaxim V.

Вед. науч. сотр., отдел лучевых методов диагностики ГБУЗ «НИИ неотложной детской хирургии и травматологии — Клиника доктора Рошаля» ДЗМ

e-mail: maxublinsk@mail.ru

Leading researcher, Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr Roshal’s Clinic

e-mail: maxublinsk@mail.ru

maxublinsk@mail.ruhttps://orcid.org/0000-0002-5142-9400КаньшинаДарья СергеевнаKanshinaDarya S.

Канд. мед. наук, ст. науч. сотр., ГБУЗ «НИИ НДХиТ — Клиника доктора Рошаля» ДЗМ

e-mail: dr.d.kanshina@gmail.com

https://orcid.org/0000-0002-4709-9461БожкоОльга ВасильевнаBozhkoOlga V.

Канд. мед. наук, ст. науч. сотр., ГБУЗ «НИИ НДХиТ — Клиника доктора Рошаля» ДЗМ

e-mail: bozhko_olga@mail.ru

https://orcid.org/0000-0002-9450-7827ЯковлевАлексей НиколаевичYakovlevAleksey N.

Науч. сотр., ГБУЗ «НИИ НДХиТ — Клиника доктора Рошаля» ДЗМ

e-mail: yakovlevalekcej@bk.ru

https://orcid.org/0000-0002-1698-0547ХусаиноваДарья НиколаевнаKhusainovaDarya N.

Науч. сотр., ГБУЗ НИИ «НДХиТ — Клиника док тора Рошаля» ДЗМ

e-mail: dsavina@yandex.ru

ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии — Клиника доктора Рошаля» Департамента здравоохранения г. МосквыClinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr Roshal’s Clinic202529102025285329336Copyright © Ахадов Т.А., Ублинский М.В., Каньшина Д.С., Божко О.В., Яковлев А.Н., Хусаинова Д.Н., 20252025Ахадов Т.А., Ублинский М.В., Каньшина Д.С., Божко О.В., Яковлев А.Н., Хусаинова Д.Н.Akhadov T.A., Ublinskiy M.V., Kanshina D.S., Bozhko O.V., Yakovlev A.N., Khusainova D.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rosped.ru/jour/article/view/1821Введение

Введение. Нейровизуализация является обязательной частью диагностического процесса и наблюдения за больными с геморрагическим инсультом (ГИ). Она необходима для распознавания и локализации очага кровоизлияния и определения его этиологии. Достижения в области нейровизуализации позволили улучшить диагностику и лечение инсульта у детей. Использование магнитно-резонансной томографии (МРТ) обеспечивает оптимальные условия для определения функционального состояния и метаболизма головного мозга. Цель работы — определить потенциальный вклад различных методов МРТ в идентификацию и характеристику ГИ у детей.

Материалы и методы

Материалы и методы. Проанализированы данные 105 детей с клиническими проявлениями ГИ, которым была выполнена МРТ головного мозга. МРТ выполнена на томографе «Philips Achieva dStream 3Т» с использованием следующих импульсных последовательностей: аксиальные Т2-ВИ SE, T2 FLAIR, диффузионно-взвешенные изображения, SWI, 3D Т1-ВИ и МР-ангиография.

Результаты

Результаты. ГИ происходили преимущественно в каротидном бассейне у 93 (88,6%) больных, у 30 (28,6%) пациентов — со смешанным бассейном кровоснабжения, в вертебробазилярном бассейне ГИ локализовались у 14 (14,6%) больных. Часто ГИ возникали в бассейне кровоснабжения проксимальных и дистальных отделов средней мозговой артерии. При этом, кроме внутримозговых гематом, у 54 (51,7%) больных были выявлены субарахноидальные кровоизлияния и у 20 (19,1%) пациентов — внутрижелудочковые кровоизлияния. У 26 (24,7%) больных было выявлено несколько геморрагических очагов. У 7 (6,7%) детей были обнаружены гематомы паранеобластического генеза — кровоизлияния в опухоль.

Заключение

Заключение. МРТ с использованием стандартизованных протоколов является оптимальным методом диагностики ГИ у детей. Внедрение сокращённых алгоритмов для тяжёлых больных и повсеместная доступность современных методик нейровизуализации могут сократить время до постановки диагноза и улучшить исходы ГИ. При этом коморбидные формы патологии, включая судороги, опухоли, инфекции и другие неврологические состояния, могут быть дифференцированы с помощью нейровизуализации.

Участие авторов

Участие авторов: Ахадов Т.А., Божко О.В., Каньшина Д.С. — концепция и дизайн исследования; Божко О.В. — проведение исследования; Ублинский М.В., Божко О.В., Яковлев А.Н. — сбор и обработка материала; Ублинский М.В., Хусаинова Д.Н. — статистическая обработка;Ахадов T.A. — написание текста; Ахадов T.A., Божко О.В., Ублинский М.В. — редактирование. Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 12

Поступила 12.09.2025Принята к печати 02.10.2025Опубликована 30.10.2025

Introduction

Introduction. Neuroimaging is an essential part of the diagnostic process and monitoring of patients with hemorrhagic stroke (HS). Its role is to recognize and localize the hemorrhage site and to determine its etiology. Advances in neuroimaging have increased the capabilities and improved the diagnosis and treatment of stroke in children. In this regard, magnetic resonance imaging (MRI) has made significant progress in recent years, achieving significant advances in the assessment of brain physiology, function, and metabolism, which have not previously been routinely assessed in the clinical setting. Purpose. To determine the potential contribution of different MRI techniques to the identification and characterization of hemorrhagic stroke in children.

Materials and methods

Materials and methods. Data from one hundred five children with clinical manifestations of stroke who underwent MRI in the radiology department were analyzed. MRI was performed on a Philips Achieva dStream 3 T scanner using the following pulse sequences: axial T2-WI SE, T2 FLAIR, diffusion-weighted images (DWI), SWI, 3D T1 WI, and MR angiography.

Results

Results. HS most often occurred in the carotid basin in 93 (88.6%) patients, including 30 (28.6%) with a mixed blood supply basin, while only 14 (14.6%) patients localized them in the vertebrobasilar basin. Most often, HS occurs in the blood supply basin of the proximal and distal parts of the middle cerebral artery (MCA). In addition to intracerebral hematomas, subarachnoid hemorrhages (SAH) and intraventricular hemorrhages (IVH) were detected in 54 (51.7%) cases. Several hemorrhagic foci were detected in 26 (24.7%) patients. Hematomas were detected in 7 (6.7%) children — HS of paraneoblastic genesis — hemorrhages into the tumor.

Conclusion

Conclusion. MRI using standardized protocols is currently the optimal standard for the diagnosis of hemorrhagic stroke in children. The introduction of shortened algorithms for severe patients and the widespread expansion of the availability of modern neuroimaging techniques can reduce the time to diagnosis and improve outcomes. HS mimics, including seizures, tumor, infection and other acute neurological conditions should be differentiated using neuroimaging.

Contribution

Contribution: Akhadov T.A., Bozhko O.V., Kanshina D.S. — study concept and design; Bozhko O.V. — study implementation; Ublinsky M.V., Bozhko O.V., Yakovlev A.N. — data collection and processing; Ublinsky M.V., Khusainova D.N. — statistical processing; Akhadov T.A. — writing the text; Akhadov T.A., Bozhko O.V., Ublinsky M.V. — editing the text. All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: September 12, 2025

Accepted

Accepted: October 02, 2025

Published

Published: October 30, 2025

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The authors declare that there are no conflicts of interest present.