Cervical arterial dissection is one of the frequent causes of pediatric arterial ischemic stroke. Out of concern over missing cervical arterial dissection in patients where pediatric stroke is suspected, our tertiary children’s hospital has added post-contrast 3D neck MR angiography to every MRI for a pediatric stroke workup, with the option to limit the examination to DWI and MRA circle of Willis (COW) only if an acute stroke was seen and administration of TPA was considered.

The institutional PACS database was searched using Montage (Montage Healthcare Solutions, Philadelphia, PA) for stroke protocol MRIs that included DWI, GRE or SWI, circle of Willis MRA and 3D post-contrast neck MRA in patients less than 18 years of age and with examinations performed between September 2010 and June 2017. Reports were reviewed for abnormalities on DWI, SWI/GRE, MRA COW, and MRA neck portions of the examination.

The search results included 1147 examinations in 888 unique patients (522 male, average age 10.8 years). In only a single case (a 15 year old female with unusual history of episodic cervical ICA vasospasm) were the DWI, SWI/GRE or MRA COW all separately reported as normal and the MRA neck reported as abnormal for a cervical arterial abnormality.

In our large series, the addition of a routine neck MRA to our pediatric stroke MRI protocol was of extremely low yield when DWI, SWI/GRE and MRA COW were all normal. The use of neck MRA in pediatric stroke could be limited to cases where abnormalities are initially detected on these routine brain sequences.