Brain Imaging in Patients with Transient Ischemic Attack: A Comparison of Computed Tomography and Magnetic Resonance Imaging

Förster, Alex; Gass, Achim; Kern, R.; Ay, Halil; Chatzikonstantinou, Anastasios; Hennerici, Michael G.; Szabo, Kristina

doi:10.1159/000333286

Cited by 42 publications

(28 citation statements)

References 23 publications

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“…35,69,81,122,138,150,158,249,251 A recent multicentre study showed that the proportion of patients with final diagnosis of TIA and visible lesion on CT was 23.9%; however, it is unclear if this was just the relevant lesion and in many cases it was an old and irrelevant lesion. 211 In patients with diagnosis of minor stroke, the proportion of patients with a visible relevant lesion on CT ranged from 42% to 52% (ESS data 111 ).…”

Section: Prognosis Among Patients With Suspected Transient Ischaemic mentioning

confidence: 99%

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

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BackgroundPatients with transient ischaemic attack (TIA) or minor stroke need rapid treatment of risk factors to prevent recurrent stroke. ABCD2 score or magnetic resonance diffusion-weighted brain imaging (MR DWI) may help assessment and treatment.ObjectivesIs MR with DWI cost-effective in stroke prevention compared with computed tomography (CT) brain scanning in all patients, in specific subgroups or as ‘one-stop’ brain-carotid imaging? What is the current UK availability of services for stroke prevention?Data sourcesPublished literature; stroke registries, audit and randomised clinical trials; national databases; survey of UK clinical and imaging services for stroke; expert opinion.Review methodsSystematic reviews and meta-analyses of published/unpublished data. Decision-analytic model of stroke prevention including on a 20-year time horizon including nine representative imaging scenarios.ResultsThe pooled recurrent stroke rate after TIA (53 studies, 30,558 patients) is 5.2% [95% confidence interval (CI) 3.9% to 5.9%] by 7 days, and 6.7% (5.2% to 8.7%) at 90 days. ABCD2 score does not identify patients with key stroke causes or identify mimics: 66% of specialist-diagnosed true TIAs and 35–41% of mimics had an ABCD2 score of ≥ 4; 20% of true TIAs with ABCD2 score of < 4 had key risk factors. MR DWI (45 studies, 9078 patients) showed an acute ischaemic lesion in 34.3% (95% CI 30.5% to 38.4%) of TIA, 69% of minor stroke patients, i.e. two-thirds of TIA patients are DWI negative. TIA mimics (16 studies, 14,542 patients) make up 40–45% of patients attending clinics. UK survey (45% response) showed most secondary prevention started prior to clinic, 85% of primary brain imaging was same-day CT; 51–54% of patients had MR, mostly additional to CT, on average 1 week later; 55% omitted blood-sensitive MR sequences. Compared with ‘CT scan all patients’ MR was more expensive and no more cost-effective, except for patients presenting at > 1 week after symptoms to diagnose haemorrhage; strategies that triaged patients with low ABCD2 scores for slow investigation or treated DWI-negative patients as non-TIA/minor stroke prevented fewer strokes and increased costs. ‘One-stop’ CT/MR angiographic-plus-brain imaging was not cost-effective.LimitationsData on sensitivity/specificity of MR in TIA/minor stroke, stroke costs, prognosis of TIA mimics and accuracy of ABCD2 score by non-specialists are sparse or absent; all analysis had substantial heterogeneity.ConclusionsMagnetic resonance with DWI is not cost-effective for secondary stroke prevention. MR was most helpful in patients presenting at > 1 week after symptoms if blood-sensitive sequences were used. ABCD2 score is unlikely to facilitate patient triage by non-stroke specialists. Rapid specialist assessment, CT brain scanning and identification of serious underlying stroke causes is the most cost-effective stroke prevention strategy.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Prognosis Among Patients With Suspected Transient Ischaemic mentioning

confidence: 99%

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

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“…16 More recently, a study of 161 tia patients, who underwent both Ct and Mri, indicated focal Ct abnormalities in seven (4.3%) patients. 26 the overall agreement between Ct and Mri in detecting ischemic lesions was 69%, indicating that approximately one third of identified dWi lesions were missed or misidentified (i.e. chronic lesions classified as acute relevant infarct) on Ct.…”

Section: Imaging Studies In Tia Patientsmentioning

confidence: 99%

Factors Associated with Cognitive Decline in Transient Ischemic Attack Patients

Sivakumar

Camicioli

Butcher

2014

Can. J. Neurol. Sci.

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Stroke is the leading cause of prolonged disability in the elderly and the second most common cause of death. 1,2 prior to stroke individuals often experience minor cerebrovascular events such as transient ischemic attacks (tias). according to the World health organization criteria, a tia is defined as a focal neurological deficit lasting for less than 24 hours and presumed to be of vascular origin. 3 these events have been considered crucial "warning signs" for increased risk of an upcoming stroke. Stroke has been shown to follow a tia in 12 to 30% of patients, and the highest risk of recurrent cerebral ischemia is within the first 24 hours of the initial event. 4 Without early detection and proper treatment, tias can be followed by more severe ischemic stroke.Cerebrovascular disease is associated with cognitive impairment that significantly impacts patients in the long term. up to 25% of stroke survivors meet the criteria for dementia within 12 months of an ischemic event. 5,6 . Chronic cerebrovascular changes, without overt clinical evidence of an ischemic stroke, can lead to cognitive decline, ultimately resulting in vascular dementia. in tia patients, symptoms and tissue deficits are by definition considered temporary, but cognitive impairments have been identified in some studies after initial focal symptoms have resolved.7-9 imaging studies in tia/minor stroke patients have identified correlates of cognitive deficits, but a profile describing how cognitive changes evolve over time has not been established. it is unknown whether cognitive impairments remain stable, worsen, or resolve in time ABSTRACT: Chronic cerebrovascular disease and large ischemic stroke are both associated with cognitive impairment. Much less is known about the acute cognitive sequelae of transient ischemic attack (tia). although often overlooked, there is increasing evidence that cognitive impairment does occur following tia. in some patients, cognitive changes persist after resolution of focal neurological deficits, but the temporal profile of these symptoms is unknown. in addition, clinical and imaging correlates of cognitive impairment after tia have not been systematically studied. this under-studied and recognized problem has significant implications for tia patient management. in this review, we summarize the evidence currently available and identify future research priorities.RÉSUMÉ: Facteurs associés au déclin cognitif chez les patients présentant un accident ischémique transitoire. la maladie vasculaire cérébrale chronique et l'accident vasculaire cérébral extensif sont tous deux associés à un déficit cognitif. on connaît moins bien les séquelles cognitives aiguës d'un accident ischémique transitoire (ait). bien que ce soit rarement pris en compte, il y a de plus en plus de données en faveur de la présence d'un déficit cognitif suite à un ait. Chez certains patients, les changements cognitifs persistent après la résolution des déficits neurologiques focaux, mais le profil temporel de ces symptômes demeure inconnu. de plus, l...

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“…A transversal diffusion‐weighted series is appreciated in the evaluation of restricted water diffusion in brain tissue as a sign of cytotoxic oedema. DWI has a superior sensitivity in the detection of acute ischaemia compared to CT and shows areas of cytotoxic oedema as soon as 3–11 min after onset of AIS . It is possible to visualize very small ischaemic areas even in the posterior fossa .…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Radiological imaging in acute ischaemic stroke

Kurz

Ringstad

Odland

et al. 2015

Euro J of Neurology

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Patients who suffer acute ischaemic stroke can be treated with thrombolysis if therapy is initiated early. Radiological evaluation of the intracranial tissue before such therapy can be given is mandatory. In this review current radiological diagnostic strategies are discussed for this patient group. Beyond non-enhanced computed tomography (CT), the standard imaging method for many years, more sophisticated CT stroke protocols including CT angiography and CT perfusion have been developed, and additionally an increasing number of patients are examined with magnetic resonance imaging as the first imaging method used. Advantages and challenges of the different methods are discussed.

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Brain Imaging in Patients with Transient Ischemic Attack: A Comparison of Computed Tomography and Magnetic Resonance Imaging

Cited by 42 publications

References 23 publications

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Factors Associated with Cognitive Decline in Transient Ischemic Attack Patients

Radiological imaging in acute ischaemic stroke

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