Abstract
Objectives: The present study aimed to examine the prevalence of and risk factors for magnetic resonance (MR) perfusion abnormality in a Chinese population with transient ischemic attack (TIA) and normal diffusion-weighted imaging (DWI) findings.Methods: Patients with TIA admitted to our stroke center between January 2015 and October 2017 were recruited to the present study. MRI, including both DWI and perfusion-weighted imaging (PWI), was performed within 7 days of symptom onset. Time to maximum of the residue function (Tmax) maps were evaluated using the RAPID software (Ischemaview USA, Version 4.9) to determine hypoperfusion. Multivariate analysis was used to assess perfusion findings, clinical variables, medical history, cardio-metabolic, and the ABCD2 scores (age, blood pressure, clinical features, symptom duration, and diabetes).Results: Fifty-nine patients met the inclusion criteria. The prevalence of MR perfusion Tmax ≥ 4 s ≥ 0 ml and ≥ 10 mL were 72.9% (43/59) and 42.4% (25/59), respectively. Multivariate analyses revealed that history of hypertension is an independent factor associated with MR perfusion abnormality (Tmax ≥ 4 s ≥ 10 mL) for Chinese patients with TIA (P = 0.033, adjusted OR = 4.11, 95% CI = 1.12–15.11). Proximal artery stenosis (>50%) tended to lead to a larger PW lesion on MRI (p = 0.067, adjusted OR = 3.60, 95% CI = 0.91–14.20).Conclusion: Our results suggest that the prevalence of perfusion abnormality is high as assessed by RAPID using the parametric Tmax ≥ 4 s. History of hypertension is a strong predictor of focal perfusion abnormality as calculated by RAPID on Tmax map of TIA patients with negative DWI findings.
Highlights
Transient ischemic attack (TIA) has been redefined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without evidence of acute infarction [1]
The inclusion criteria for this study: (a) patients presented with TIA and evaluated by a certified stroke neurologist at the time of admission and discharge, diagnosis of TIA was confirmed by two certified stroke neurologists; (b) MRI including both DWI and perfusion-weighted imaging (PWI) within 7 days of symptom onset, and no DWI evidence of restricted diffusion; (c) Time to maximum of the residue function (Tmax) maps were assessed independently using the RAPID software (Ischemaview USA, Version 4.9)
We found that among Chinese patients with acute TIA, history of hypertension is an independent factor associated with MR perfusion abnormality (Tmax ≥ 4 s ≥ 10 mL)
Summary
Transient ischemic attack (TIA) has been redefined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without evidence of acute infarction [1]. TIA is associated with high risk of early subsequent stroke up to 20% of patients [3]. TIA has been evaluated as a major risk factor for future recurrent ischemic attacks, and emergent diagnosis of the cause is needed to ensure timely treatment and to dramatically reduce the risk of developing strokes [4,5,6]. Prognosis of TIA depends on its pathological basis, and early identification of high-risk patients with TIA and timely treatment. The ABCD2 prediction score (range 0–7, age, blood pressure, clinical symptoms, duration, and diabetes) was originally intended to aid non-specialists in community and emergency department settings to improve risk stratification of patients with transient neurological symptoms, and had little specificity between hospital-based neurologists [7]. Evaluation using imaging techniques is essential for administering the proper medications to treat or prevent TIA and the consequent stroke, which will refine the clinical diagnosis of TIA
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