Magnetic resonance imaging in the diagnosis of hemorrhagic strokes in children

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. 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. 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. 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:
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. The study had no sponsorship.

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

Received: September 12, 2025

Accepted: October 02, 2025

Published: October 30, 2025

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