Incidence and Predictors of Acute Ischemic Lesions on Brain Magnetic Resonance Imaging in Patients With a Clinical Diagnosis of Transient Ischemic Attack in China.

Junliang Yuan,Yangguang Song,Yue Li,Zejin Jia,Shuna Yang,Lei Yang,Wei Qin,Wenli Hu

doi:10.3389/fneur.2019.00764

Junliang Yuan, Yangguang Song + Show 6 more

Open Access

https://doi.org/10.3389/fneur.2019.00764

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Abstract

Background: The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients.Methods: Between Jan 2017 and Dec 2018, we retrospectively enrolled 430 patients with a clinical diagnosis of TIA who underwent DWI. Patients were divided into those with acute ischemic lesions (DWI positive group) and those without (DWI negative group). The clinical characteristics, laboratory data, and imaging parameters were compared between the two groups.Results: A total of 430 time-based TIA patients (mean age, 61.4 ± 13.0) were enrolled in this study. About 126 (29.3%) of TIA patients had a DWI positive lesion in our series. Comparing TIA patients with positive DWI to those with negative DWI, acute lesions were more likely to be more male, have higher hyperlipidemia and a smoking history, more speech abnormalities and increased motor weakness; and higher systolic and diastolic blood pressure, homocysteine, fasting blood glucose, and the scores of ABCD2, ABCD3, ABCD3-I, and Dawson. Several independent predictors of DWI positivity were identified with logistic regression analysis: motor weakness (odds ratio 4.861, P = 0.021), speech abnormalities (odds ratio 4.029, P = 0.024), and ABCD3-I (odds ratio 13.141, P = 0.001). ABCD3-I showed the greatest area under the ROC curve, with a sensitivity of 85.7% and specificity of 72.4%.Conclusion: In patients with a clinical diagnosis of TIA, 29.3% demonstrated acute DWI lesions on brain magnetic resonance imaging (MRI). They were associated with motor weakness, speech abnormalities and higher ABCD3-I score at admission.

Highlights

Stroke is the second leading cause of death worldwide, and the first cause of death in China
transient ischemic attack (TIA) was classically defined as a focal cerebral ischemic event with neurological symptoms lasting
We classified the patients with positive diffusion-weighted imaging (DWI) as stroke etiology according to the TOAST: 48 (38.1%) of large-artery atherosclerosis, 14 (11.1%) of cardioembolism, 40 (31.7%) of small artery occlusion, 4 (3.2%) of other determined etiology, 20 (15.9%) of undetermined etiology

Summary

Introduction

Stroke is the second leading cause of death worldwide, and the first cause of death in China. Several studies suggested DWI positivity in TIA was associated with clinical characteristics such as age [7], longer symptom duration [8], motor deficit, aphasia, and NIHSS score [6], and largevessel occlusion of magnetic resonance angiography (MRA) [9]. These associations between the clinical characteristics and DWI positivity are still incompletely understood. The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients

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