Abstract 16: Lenticulostriate Collaterals Predict Angiographic Course in Unilateral Focal Cerebral Arteriopathy of Childhood
Bibliographic record
Abstract
Introduction: Focal cerebral arteriopathy (FCA) is a frequent cause of stroke in children and an important risk factor for stroke recurrence. The factors affecting progression of FCA remain undetermined. Hypothesis: We hypothesized that the presence of lenticulostriate (LS) collaterals at presentation can serve as a prognostic marker of progressive arteriopathy in children with unilateral FCA. Methods: Children aged 1-month to 18-years with FCA, defined as unilateral steno-occlusive disease at the carotid terminus, were retrospectively identified from two centers. Presence of collaterals was based on digital subtraction angiography (DSA) at baseline. The patients’ imaging (MR angiogram or DSA) dataset at baseline and last follow-up was reviewed by 2 blinded raters and their outcomes classified as improved, stable, or progressed based on location and degree of steno-occlusive disease. The presence or absence of LS collaterals at presentation and angiographic outcomes were compared using Fisher’s exact test. Results: Our study included 46 children; 24 males, with median age 8.2 years (range 2-17.4 years), of which 21 had LS collaterals at presentation (46%). Median follow-up periods were 12 months and 19 months for the collateral and non-collateral groups, respectively. Angiographic improvement occurred exclusively in the non-collateral group (48%) (p=0.0001). In the collateral group, progression occurred ipsilaterally in 29%, and contralaterally in 14%. In the non-collateral group, progression was only ipsilateral, occurring in 35%. Discordant progression, defined as progression and improvement across multiple vessels, only occurred in the non-collateral group (67%) (p=0.02). No patients in the non-collateral group developed LS collaterals. Conclusion: The presence of LS collaterals in FCA was associated with ipsilateral or contralateral progression, while their absence was associated with ipsilateral progression or improvement. We conclude that LS collaterals in FCA likely signify a chronic, progressive process recognized as Moyamoya disease. In the absence of collaterals, steno-occlusion may progress in a discordant fashion or improve, indicating a varied vascular response to injury or inflammation, and the capacity to heal.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".