Patterns of diffusion-weighted magnetic resonance imaging associated with etiology improve the accuracy of prognosis after transient ischaemic attack

Objective:  Diffusion‐weighted magnetic resonance imaging (DWI) is a sensitive diagnostic tool for detecting acute ischaemic lesions in patients with transient ischaemic attacks (TIAs). The additional predictive value of DWI lesion patterns is not well known. Methods:  Two hundred and fifty‐four con...

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Published in:European journal of neurology Vol. 18; no. 1; pp. 121 - 128
Main Authors: Purroy, F., Begué, R., Gil, M. I., Quílez, A., Sanahuja, J., Brieva, L., Piñol-Ripoll, G.
Format: Journal Article
Language:English
Published: Oxford, UK Blackwell Publishing Ltd 01.01.2011
John Wiley & Sons, Inc
Subjects:
Aged
Brain - pathology
Diffusion
Diffusion Magnetic Resonance Imaging
diffusion-weighted imaging
Female
Humans
Indexing in process
Ischemic Attack, Transient - etiology
Ischemic Attack, Transient - pathology
Logistic Models
Male
NMR
Nuclear magnetic resonance
Prognosis
Risk Factors
Stroke
transient ischaemic attack
ISSN:1351-5101, 1468-1331, 1468-1331
Online Access:Get full text
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Summary:Objective:  Diffusion‐weighted magnetic resonance imaging (DWI) is a sensitive diagnostic tool for detecting acute ischaemic lesions in patients with transient ischaemic attacks (TIAs). The additional predictive value of DWI lesion patterns is not well known. Methods:  Two hundred and fifty‐four consecutive patients with TIA underwent DWI within 7 days of symptom onset. The presence and pattern of acute ischaemic lesions were related to clinical features, etiology, and stroke recurrence at seven‐ and 90‐day follow‐up. Results:  Diffusion‐weighted images abnormalities were identified in 117 (46.1%) patients. The distribution of DWI lesions was cortical, 31; subcortical, 32; scattered lesions in one arterial territory (SPOT) 42; and in multiple areas, 12. SPOT were significantly associated with motor weakness, large‐artery atherosclerosis (LAA), and the cardioembolic subtype of TIA. Single cortical lesions were also associated with cardioembolism, whereas subcortical acute lesions were associated with recurrent episodes, dysarthria, and motor weakness. During follow‐up, seven patients had a stroke within 7 days (2.8%, 95% CI 2.9–6.4%), and 12 had a stroke within 3 months (4.7%%, 95% CI 2.9–6.4%). In the Cox logistic regression model, the combination of LAA and positive DWI remained as independent predictors of stroke recurrence at 90‐day follow‐up (HR 5.78, 95 CI 1.74–19.21, P = 0.004). Conclusion:  According to our results, MRI, including DWI, should be considered a preferred diagnostic test when investigating patients with potential TIAs. The combination of neuroimaging and vascular information could improve prognostic accuracy in patients with TIA.
Bibliography:ArticleID:ENE3080
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ISSN:1351-5101
1468-1331
1468-1331
DOI:10.1111/j.1468-1331.2010.03080.x