History of Hypertension Is Associated With MR Hypoperfusion in Chinese Inpatients With DWI-Negative TIA

Abstract

Objectives: The present study aimed to examine the prevalence of and risk factors for magnetic resonance (MR) perfusion abnormality in a Chinese population with transient ischemic attack (TIA) and normal diffusion-weighted imaging (DWI) findings. Methods: Patients with TIA admitted to our stroke center between January 2015 and October 2017 were recruited to the present study. MRI, including both DWI and perfusion-weighted imaging (PWI), was performed within 7 days of symptom onset. Time to maximum of the residue function (T max ) maps were evaluated using the RAPID software (Ischemaview USA, Version 4.9) to determine hypoperfusion. Multivariate analysis was used to assess perfusion findings, clinical variables, medical history, cardio-metabolic, and the ABCD2 scores (age, blood pressure, clinical features, symptom duration, and diabetes). Results: Fifty-nine patients met the inclusion criteria. The prevalence of MR perfusion T max ≥ 4 s ≥ 0 ml and ≥ 10 mL were 72.9% (43/59) and 42.4% (25/59), respectively. Multivariate analyses revealed that history of hypertension is an independent factor associated with MR perfusion abnormality (T max ≥ 4 s ≥ 10 mL) for Chinese patients with TIA ( P = 0.033, adjusted OR = 4.11, 95% CI = 1.12–15.11). Proximal artery stenosis (>50%) tended to lead to a larger PW lesion on MRI ( p = 0.067, adjusted OR = 3.60, 95% CI = 0.91–14.20). Conclusion: Our results suggest that the prevalence of perfusion abnormality is high as assessed by RAPID using the parametric T max ≥ 4 s. History of hypertension is a strong predictor of focal perfusion abnormality as calculated by RAPID on T max map of TIA patients with negative DWI findings.

Vasculo-Neuronal Coupling and Neurovascular Coupling at the Neurovascular Unit: Impact of Hypertension

“…They also observed a strong correlation between hypertension and perfusion abnormalities that was independent of the ischemic attack (Wang et al, 2019b). Hypertension, together with hypoperfusion, can result in significant dysregulation of cerebral vessels, increasing vascular resistance and exacerbating myogenic constriction (Iddings et al, 2015).…”

“…Using MRI analyses and clinical history data for 59 patients who suffered a transient ischemic attack, Wang and colleagues reported that 67.8% of such patients presented a history of hypertension. They also observed a strong correlation between hypertension and perfusion abnormalities that was independent of the ischemic attack ( Wang et al, 2019b ). Hypertension, together with hypoperfusion, can result in significant dysregulation of cerebral vessels, increasing vascular resistance and exacerbating myogenic constriction ( Iddings et al, 2015 ).…”

Power of Hypoperfusion in Predicting Recurrent Transient Ischemic Attacks: Protocol of a Prospective Cohort Study

“…MRI-based hypoperfusion in patients with TIA is closely related to the time of completing MR imaging. A recent study has shown that hypoperfusion, detected by MRI, is present in 42.4% (25/59) of patients with TIA, and the median (IQR) time of symptom onset to baseline MR-PWI was 5 (4–9) days (Wang et al, 2019a ). This is similar to the results of a previous study that has demonstrated the presence of hypoperfusion in 42% (57/137) of patients with TIA, with a median time of 9.2 h from symptom onset to completing MR-PWI (Asdaghi et al, 2013 ).…”

“…Estimates of the volume of hypoperfusion on MRI perfusion scans are performed using the RAPID software, which is an automated image post-processing software (Rothwell et al, 2007 ; Wang et al, 2019a ). Lesion volume of T max ≥ 4 s ≥ 10 ml is used for determining perfusion deficits in patients with TIA (Liu et al, 2007 ; Najib et al, 2019 ).…”

“…There are many modalities for assessing hypoperfusion. Although mean transit time (MTT) and time to peak (TTP) can be used to observe abnormal changes in perfusion in patients with TIA (Kleinman et al, 2012 ), time-to-maximum of residue function ( T max ) ≥ 4 s is currently the best one for evaluating perfusion abnormalities in the early stage (Olivot et al, 2009 ; Wang et al, 2019a , b ). The previous results showed that the prevalence of T max ≥ 4 s > 10 ml was 50% (33/66).…”