Computed tomography perfusion imaging may predict cognitive impairment in patients with first-time anterior circulation transient ischemic attack

Abstract

To determine whether computed tomography perfusion imaging (CTPI)-derived parameters are associated with vascular cognitive impairment (VCI) in patients with transient ischemic attack (TIA). Patients with first-time anterior circulation TIA (diagnosed within 24 h of onset) and normal cognition, treated between August 2009 and August 2014 at the Department of Neurology of Chengdu Military General Hospital, China, were analyzed retrospectively. Patients underwent whole-brain CTPI within 1 week of TIA to detect cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) in the ischemic region. Based on cognitive function assessment 4 weeks after TIA, using the Montreal cognitive assessment (MoCA) and mini mental state examination, the patients were divided into control and VCI groups. CTPI parameters and other clinical data were compared between groups, and Spearman's correlation analysis used to identify associations between cognitive scores and CTPI parameters in the VCI group. 50 patients (25 per group; aged 55-72 years) were included. Patient age, gender, smoking status, alcohol consumption, educational level, time from TIA onset to admission, time from TIA onset to CTPI, and prevalence of hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation and hyperhomocysteinemia did not differ between groups. Both groups showed TTP and MTT prolongation, CBF reduction, but no change in CBV in the ischemic region; these changes were significantly larger in the VCI group (P < 0.05). MTT correlated negatively with MoCA score (r = -0.51, P = 0.009). CTPI could facilitate early diagnosis of VCI in patients with anterior circulation TIA.

Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

“…Some studies have proposed that cerebral BFV can reflect the brain perfusion as well as cognitive dysfunctions [25]. Wang et al reported significant CBF reduction in patients with anterior circulation TIA who had vascular cognitive impairment [26]. Patients with carotid atherosclerosis showed lower scores in verbal fluency test even when the atherosclerosis were subclinical [27], and verbal fluency was improved after carotid artery stenting or carotid endarterectomy for patients with carotid artery stenosis [28].…”

Cognitive testing following transient ischaemic attack: A systematic review of clinical assessment tools

“…MoCA and MMSE scores were lower in stroke than TIA (20 vs 24, and 26 vs 28 respectively). Post-acute - Within 1 month J. Wang et al ( 2016 ) 50% China 50 (25 with VCI, 25 no-VIC or control) Inpatient MoCA, MMSE 4 weeks post-TIA 25 healthy controls CTP changes greater in patients with cognitive impairment at 4 weeks post-TIA. Negative correlation between MoCA score and CTP parameters in patients.…”

“…Four studies performed cognitive testing one-month post-TIA. Of these four studies, one used a neuropsychological battery compared to minor surgery patients (Charoenkitkarn et al, 2009 ), one used the MoCA with no comparison group (Kjörk et al, 2016 ), one used the MMSE compared to non-cerebrovascular patients (Pendlebury et al, 2011 ), and one used the MoCA and MMSE compared to healthy controls (J. Wang et al, 2016 ). All four studies identified cognitive impairment in TIA patients (19–50%).…”

Imaging Diagnosis of Transient Ischemic Attack in Clinic and Traditional Chinese Medicine

“…And the degree of impairment of CVR is closely related to the change of MTT, which was observed in a study from August 2009 to August 2014 [42]. Wang summarized that changed parameters that MTT prolonged, CBV increased, and oxygen uptake fraction (OEF) invariant indicates vascular reflex expansion; CBF decreases, OEF increases, and means brain metabolism reserve mechanism begins to take effect [42]. One study used 48 mice to compare CTP, Triphenyltetrazolium chloride (TTC) staining and hematoxylin-eosin staining, and CTP showed consistent infarct volume calculated in TTC staining and CBV showed the highest correlation [43].…”

“…The examination of CTP is very rapid, and the parameter MTT is highly sensitive to cerebral blood flow reperfusion. And the degree of impairment of CVR is closely related to the change of MTT, which was observed in a study from August 2009 to August 2014 [42]. Wang summarized that changed parameters that MTT prolonged, CBV increased, and oxygen uptake fraction (OEF) invariant indicates vascular reflex expansion; CBF decreases, OEF increases, and means brain metabolism reserve mechanism begins to take effect [42].…”