Diagnostic and Prognostic Value of Multimodal MRI in Transient Ischemic Attack

Nah, Hyun‐Wook; Kwon, Sun U.; Kang, Dong‐Wha; Lee, Deok-Hee; Kim, Jong Seung

doi:10.1111/ijs.12212

Cited by 21 publications

(18 citation statements)

References 22 publications

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“…In spite that our data were not as perfect as Dutta D study, however, our findings were consistent with it. It was reported that the AUC of ABCD2 score and ABCD3-I score was 0.50 and 0.58 in South Korea population [30]. In the population of Spain, the area under the ROC curve of ABCD2 and ABCD3-I for ischemic events prediction were 0.49 and 0.77 [31].…”

Section: Discussionmentioning

confidence: 96%

Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

Jia¹,

Song²,

Yuan³

2019

Preprint

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Background: Recently, [the diagnosis of transient ischemic attack (TIA), DOT) score was considered to be a new tool for non-specialists to diagnose TIA more accurately with the sensitivity and specificity were 89% and 76%. However, the DOT score has not yet been validated externally in patients with TIA in China. Methods: We prospectively enrolled consecutive 500 patients with transient neurological symptoms, who were admitted to our hospital and underwent magnetic resonance imaging (MRI) during hospitalization between Jan 2016 and Dec 2018. Patients with transient neurological symptoms were divided into two subgroups: TIA mimic group (N=140, 28%) and definite cerebrovascular events group (including tissue-based TIA (N=252, 50.4%) and minor stroke (N=108, 21.6%)). The demographic data, clinical characteristics, laboratory findings and scores of ABCD2, ABCD3-I, Dawson and DOT were compared between the two groups. Results: A total of 500 patients with transient neurological symptoms (mean age, 61.1±12.8) were enrolled and 70% (N=350) were male. Comparing with TIA mimic groups, patients with definite cerebrovascular events group were correlated with higher diastolic blood pressure, higher proportion of motor weakness and speech abnormalities, the higher levels of uric acid and homocysteine, and the scores of ABCD2, ABCD3-I, Dawson, and DOT. The logistic regression analysis showed diastolic blood pressure (OR 1.026, CI 1.006-1.046, P=0.011), ABCD3-I (OR 1.219, CI 1.032-1.440, P=0.020) and DOT (OR 1.462, CI 1.305-1.637, P=0.001) were independently predicted the occurrence of definite cerebrovascular events. The score of DOT showed the greatest area under the ROC curve (AUC=0.728), with a sensitivity of 70.3% and specificity of 62.9%, respectively. The optimal cut point for DOT was 0.455 using the Youden Index. Conclusion: Our findings showed DOT score performed relatively good calibration and discrimination. As a novel tool of TIA, further validations are needed externally in patients with TIA with multiple centers in large samples in China.

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Section: Discussionmentioning

confidence: 96%

Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

Jia¹,

Song²,

Yuan³

2019

Preprint

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“…With advances in MRI, up to three-quarters of TIAs defined by the traditional time-based definition have been found to have evidence of tissue damage. 19 This has sparked a shift towards use of a tissue-based definition of TIA. However, timely access to MRI and expert interpretation is not always available, and MRI is not cost-effective compared to CT. 20 It also remains to be seen whether use of plasminogen activator in patients with recent prior clinical symptoms lasting <24 hours associated with small MRI lesions is safe and effective.…”

Section: Discussionmentioning

confidence: 99%

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Hosier

Phillips

Doucette

et al. 2016

CJEM

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Objectives: 1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic. Methods: Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission. Results: Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p < 0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08-0.99, p = 0.048). Conclusion: The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death. RÉSUMÉObjectifs: L'étude visait, d'une part, à examiner si la prise en charge des accidents ischémiques transitoires (AIT) au service des urgences de la région sanitaire Nova Scotia Capital District Health Authority respectait les recommandations canadiennes en matière de pratiques exemplaires, et, d'autre part, à évaluer l'incidence du suivi dans un service de consultations externes, spécialisé en maladies neurovasculaires. Méthode: Les auteurs ont procédé à un examen rétrospectif des dossiers de tous les patients chez qui avait été posé un diagnostic d'AIT et qui avaient reçu leur congé du SU, dans la région mentionnée, et ce, du 1 er janvier 2011 au 31 décembre 2012. La mortalité et le taux de réadmission au bout de 90 jours ont été calculés à l'aide de modèles de risques proportionnels de Cox, de la méthode d'estimation de Kaplan-Meyer et d'analyses appariées de propension. Résultats: Sur 686 patients examinés au SU pour un AIT, 88,3% ont été soumis à une tomodensitométrie (TDM); 86,3%, à un ECG; 35%, à un examen par imagerie vasculaire dans les 24 heures suivant le triage et 36% ont été vus dans un service de consultations spécialisé en maladies neurovasculaires; 4,2% ont subi un accident vasculaire cérébral (AVC) ou un infarctus du myocarde (...

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“…The study was approved by the ethics committee of our center. For the prospective cohort we enrolled 162 consecutive TIA patients who visited Asan Medical Center (AMC) within 72 hours of symptom onset between July 2009 and December 2011 8. TIA was defined as a brief loss of brain function (lasting less than 24 hours) that was presumed to be due to cerebral ischemia.…”

Section: Methodsmentioning

confidence: 99%

“…The detailed protocol and parameters of MRI have been described previously 8. The MRI images were assessed independently by two stroke neurologists who were blinded to clinical data, with discrepancies resolved by consensus.…”

Section: Methodsmentioning

confidence: 99%

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Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack

et al. 2017

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Background and PurposeThe absence of acute ischemic lesions in diffusion-weighted imaging (DWI) in transient ischemic attack (TIA) patients makes it difficult to diagnose the true vascular etiologies. Among patients with DWI-negative TIA, we investigated whether the presence of a perfusion-weighted imaging (PWI) abnormality implied a true vascular event by identifying new acute ischemic lesions in follow-up magnetic resonance imaging (MRI) in areas corresponding to the initial PWI abnormality.MethodsThe included patients underwent DWI and PWI within 72 hours of TIA and also follow-up DWI at 3 days after the initial MRI. These patients had visited the emergency room between July 2009 and May 2015. Patients who demonstrated initial DWI lesions were excluded. The initial PWI abnormalities in the corresponding vascular territory were visually classified into three patterns: no abnormality, focal abnormality, and territorial abnormality.ResultsNo DWI lesions were evident in initial MRI in 345 of the 443 TIA patients. Follow-up DWI was applied to 87 of these 345 DWI-negative TIA patients. Initial PWI abnormalities were significantly associated with follow-up DWI abnormalities: 8 of 43 patients with no PWI abnormalities (18.6%) had new ischemic lesions, whereas 13 of 16 patients with focal perfusion abnormalities (81.2%) had new ischemic lesions in the areas of initial PWI abnormalities [odds ratio (OR)=15.1, 95% confidence interval (CI)=3.6–62.9], and 14 of 28 patients with territorial perfusion abnormalities (50%) had new lesions (OR=3.7, 95% CI=1.2–11.5).ConclusionsPWI is useful in defining whether or not the transient neurological symptoms in DWI-negative TIA are true vascular events, and will help to improve the understanding of the pathomechanism of TIA.

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Diagnostic and Prognostic Value of Multimodal MRI in Transient Ischemic Attack

Cited by 21 publications

References 22 publications

Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack

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